Auto-Draft Application

Utility Billing Account Information

Name on Utility Account

Service Address

City

Zip Code

Home Phone

Work Phone

Utility Billing Account # (9digits) no dashes needed

BANK INFORMATION

Bank Name

9 digit Routing Number must be 9 digits

Your Bank Account Number

Your E-mail Address

By filling out and submitting this form I am authorizing the Improvement District
to automatically debit my account each month to pay my utility bill.

Name on Utility Account
Service Address
City
Zip Code
Home Phone
Work Phone
Utility Billing Account # (9digits)	no dashes needed
BANK INFORMATION Bank Name
9 digit Routing Number	must be 9 digits
Your Bank Account Number
Your E-mail Address