subject_line
Please complete and submit the form to setup automatic bank draft payments for your utility accounts.
Date
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+
Name on Account
*
Account Number
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Service Address
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Banking Information
Bank Name
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Bank Routing Number (9 Digits)
*
Bank Account Number
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Copy of Banking Information
*
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Copy of Banking Information (if a second image is needed)
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Bank Account Type
*
Checking
Savings
Contact and Acknowledgement Information
Phone Number
*
Email
*
Verify Email
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Account holder should continue to pay bill until receiving first bill that indicates the bill has been “Paid by Draft”. Direct payments will be sent to the bank on the penalty date each month (no exceptions). Applicant agrees to indemnify the City of Lawrenceville from any liability arising from the operation of this agreement except the City shall reimburse the applicant for all sums improperly debited from the account and credited to the account of the City of Lawrenceville.
This authority is to remain in full force and effect until the Billing Department at the City of Lawrenceville has received written notification from the account holder of its termination. Allow the City of Lawrenceville and Bank a reasonable opportunity to act on it. (A “reasonable opportunity” shall not be less than 60 days.)
An account that receives an insufficient funds notice will be assessed a penalty of thirty dollars ($30.00). Any account with two (2) returned direct payments for insufficient funds will be removed from automatic bank draft.
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Agree
Account holder should continue to pay bill until receiving first bill that indicates the bill has been “Paid by Draft”. Direct payments will be sent to the bank on the penalty date each month (no exceptions). Applicant agrees to indemnify the City of Lawrenceville from any liability arising from the operation of this agreement except the City shall reimburse the applicant for all sums improperly debited from the account and credited to the account of the City of Lawrenceville.
This authority is to remain in full force and effect until the Billing Department at the City of Lawrenceville has received written notification from the account holder of its termination. Allow the City of Lawrenceville and Bank a reasonable opportunity to act on it. (A “reasonable opportunity” shall not be less than 60 days.)
An account that receives an insufficient funds notice will be assessed a penalty of thirty dollars ($30.00). Any account with two (2) returned direct payments for insufficient funds will be removed from automatic bank draft.
*
Agree