Automatic Payment Authorization

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Automatic Payment Authorization
I (we) hereby authorize the VILLAGE OF BAY CITY – WATER/SEWER/GARBAGE UTILITIES to deduct funds from my (our) checking or savings account indicated below at the FINANCIAL INSTITUTION named below.
Financial Institution Address
Financial Institution Address
City
State/Province
Zip/Postal
Account Type
This authorization is to remain in full force and effect until the VILLAGE OF BAY CITY – WATER/SEWER/GARBAGE UTILITIES and FINANCIAL INSTITUTION has received written notification from me (or either of us) of its termination in such time and in such manner as to afford the VILLAGE OF BAY CITY – WATER/SEWER/GARBAGE UTILITIES and FINANCIAL INSTITUTION a reasonable opportunity to act on it.
Property Address
Property Address
City
State/Province
Zip/Postal
Checking Account: Please attach a voided check to this agreement.
Savings Account: Check with your financial institution to verify routing and account number.

FUNDS WILL BE REMOVED FROM YOUR ACCOUNT ON THE BILLING DUE DATE FOR THE AMOUNT DUE.

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