I (we) hereby authorize Arab Water Works to initiate debit entries to my (our) bank account shown, below; and as further described by my (our) attached voided check, authorize the bank named below to debit the same to my (our) bank account. Bank:___________________________________ City: ___________________________________ It is further agreed and understood as follows: (1) The undersigned authorization is for the payment of the total amount due of my (our) Arab Water Works bill. (2) All monthly debits form my (our) bank account shall be three to five days befor the water bill due date each month. (3) The initial debit shall be effective on my (our) next water bill that is clearly marked by Arab Water Works as being "PAID BY BAND DRAFT". This will usually occur on the second or third billing cycle following the date of the authorization. (4) The monthly debits from my (our) bank account shall remain in effect until either (a) Arab Water Works concels this agreement or (b) Arab Water Works receives written termination notice from me (or either of us) in such time and manner as to afford Arab Water Works (our) bank a reasonable time to act. Customer Name (Please Print): _____________________________________________________________ Telephone Number: _____________________________________________________________________ Water bill account
number(s) that should be credited with Bank Draft Payments: Customer Signature: _____________________________________________________________________ 2nd Customer Signature, if
needed: __________________________________________________________
______________________________________________________________________________________ TRANSIT ROUTING ____________________________ ACCOUNT NUMBER ___________________________ |