Automatic Bank Draft

You are able to have your water bill paid automatically by a debit to your checking account with no fees involved. Before we can do this, we need your written authorization and a copy of a voided check from your ban k account. Please fill out the information below , sign and date, and return with a voided check to the Distr ict Office. Your bank account will be charged up to two business days before or after the penalty date . Participation in this program will automatically assure timely payment to avoid penalties. We will still send you a bill so you will know the amount of the draft. On a second occurrence of a bad "draft", a full deposit will be required and drafting will be removed from your account for one year and your account will be on a "Cash Only Basis" for one year. DO NOT EMAIL BANK ACCOUNT INFORMATION.

If you prefer, you may instead print and mail or deliver this form. [ Printable Version ]
AUTHORIZATION AGREEMENT FOR AUTOMATED PAYMENTS
(Separate Authorizations for EACH Account are Required)
Account Name*
First Middle Last
MUD Account Number*
Service Address*
Street Address Address Line 2 City State Zip Code
Phone*
Email*
I hereby authorize the LAKEWAY MUNICIPAL UT ILITY DISTRICT to in itiate debit entries to my checking account indicated below and the DEPOSITORY named below to debit same to such ac count. A voided check (or copy of same) is enclosed. This authority is to remain in full force and effect until the LAKEWAY MUNICIPAL UT ILITY DISTRICT and the DEPOSITORY have received written notification from me of its termination in such time and in s uch manner as to afford the LAKEWAY MUNICIPAL UT ILITY DISTRICT and DEPOSITORY a reasonable opportunity to act upon it.
Depository Name*
(your bank)
C/ S/ Z
Bank Routing Number*
Bank Account Number*
Upload Voided Check
Accepted file types: jpg, gif, png, pdf.
Signature
Date
Date Format: MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Automatic Bank Draft

Automatic Bank Draft

AUTHORIZATION AGREEMENT FOR AUTOMATED PAYMENTS

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