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Utility Bank Draft Request/Revoke
August 5, 2017
Step
1
of
10
10%
Name
*
Required
First
Last
I wish to:
*
Required
Set up my account for bank draft.
Remove my account from bank draft.
Driver's License Number
*
Required
For identification purposes only.
Is this utility account in your name?
*
Required
Yes
No
Account Number
City's number for your utility account.
Address
*
Required
Street Address
Name of Bank:
*
Required
Bank's Routing Number:
*
Required
Bank Account Number:
*
Required
I would like my first draft to occur:
*
Required
On the next due date (No Prenote)
On the second next due date (Prenote)
Doesn't apply, I am removing my account from draft
Permissions:
*
Required
I agree
I hearby revoke this permission, as I am removing my account from draft
I hearby give authority to the CITY OF DE LEON to draw drafts against my account every month for my City bill until this authority is revoked in writing.
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