Authorization for Automatic Bank Drafting
I authorize the City of Plano Customer & Utility Services Department to charge my account for the monthly amount of services billed. I authorize the financial institution indicated below to debit such amounts from my account.
Please complete, print, and send to address below, along with a voided check or photocopy of a check.
	Checking Account Savings Account
Date
UTILITY ACCOUNT NUMBER	NAME OF FINANCIAL INSTITUTION
CUSTOMER NAME	CITY, STATE
HOME PHONE NUMBER
	____________________________________
OFFICE PHONE NUMBER
	____________________________________
EMAIL ADDRESS We will send confirmation of your request to the email address you provide.	SIGNATURE(s) As shown on your bank records.
Your authority will remain in full force and effect until the City of Plano Customer & Utility Services Department has received notification from you to cancel the authorization. To cancel your bank draft, please contact our office at 972-941-7105. Requests for adjustments of incorrect charges appearing on your water bill should be made directly to the City of Plano Customer & Utility Services Department.
City of Plano Customer & Utility Services Dept. P O Box 861990 Plano, TX 75086-1990	©2001 City of Plano, Texas
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