Automatic Bank Drafting Service Authorization Letter
Dear Sir/Madam:
Please accept this
as your authority to pay against my account each month a draft drawn by
the City of Washington for my utility bill. The amount of this draft will
vary according to the amount of my bill. I understand that my account
will be drafted on the due date as stated on the bill.
(Please Print)
Last Name: __________________________________First Name:_________________ MI:______
Washington Utilities Acct #___________________________ Phone No.: ____________________
Address: ________________________________________________________________________
City: _____________________________________State:_________________ Zip:_____________
Bank Name:____________________________________ Bank Acct. #:______________________
Location: _________________________________Transit #:_______________________________
You are hereby authorized to draw a bank draft for the payment on my monthly utility bill.
Signature: ___________________________________________Date:_______________________
Note to Utilities Customer:
Please return authorization letter and a voided check to the following address:
City of Washington
ATTN: Revenue Collections
P.O. Box 1988
Washington, NC 27889