Bank Draft Enrollment Authorization

Bank draft enrollment must be submitted by end of business week prior to due date in order to take immediate effect.

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Please complete form and return to the Utility Billing Office. See SAMPLE check above

Utility Account Number *

Name on Utility Account *

ABA Routing Number *

Bank Account Number *

Name of Bank *

Name on Bank Account *

Contact Phone Number: *

Contact E-mail:

Before submitting this document, please verify the information provided is complete and correct.

I authorize the City of Denison Utility Billing Department to charge my account monthly for the balance due on my utility account. I authorize my financial institution indicated above to debit such amounts from my account. This will remain in effect until I cancel this authorization by contacting the City of Denison Utility Billing Department. My utility account will no longer be eligible for draft enrollment for 12 months if 3 or more draft
payments are unsuccessful/returned in 12 consecutive months. Errors in the account information provided above may result in payment(s) not processing successfully. This may result in additional fees, deposits, and/or disconnection of service.

By clicking ‘I Agree’ below you acknowledge that you have read, understand, and agree to the above statement. *

I Agree

Bank Draft Enrollment Authorization

Contact Information