DECEMBER 12, 2000 - Toledo Bend
SOUTH TOLEDO BEND WATER DISTRICT
PO BOX 60
MANY, LA 71449-0060
BILLING (318)256-2725 OR –5714 FAX 256-5758
WATER PLANT (318)586-9836
Website:
RECURRING EFT PAYMENT AUTHORIZATION
NAME ON WATER ACCOUNT:
WATER ACCOUNT NUMBER:
HOME TELEPHONE NUMBER:
CELL PHONE NUMBER:
CURRENT MAILING ADDRESS:
CURRENT CITY, STATE & ZIP:
U.S. BANK ACCOUNT INFORMATION:
NAME OF FINANCIAL INSTITUTION:
CITY, STATE & ZIP CODE:
BANK CONTACT TELEPHONE #:
NAME ON BANK ACCOUNT:
BANK ACCOUNT NUMBER:
BANK ROUTING NUMBER (9-DIGIT #):
**SEND A VOIDED CHECK WITH AUTHORIZATION FORM**
CUSTOMER AUTHORIZATION:
I hereby authorize the financial institution named above to pay the monthly water bill. I have the right to stop payment of a charge by timely notification to my financial institution, and South Toledo Bend Water District reserves the right to terminate this EFT payment authorization or my participation therein. I also certify that I am an authorized signer on the above bank account.
CUSTOMER SIGNATURE:
DATE:
INSTRUCTIONS:
Please return this signed form and voided check to any of the following:
Email: cpas3@
Fax: (318)256-5758
Mail: PO Box 60, Many, LA 71449-0060
Please continue to pay your water bill with check until you see note on your bill that EFT payment will be executed for that water bill. You will continue to receive a monthly bill showing the water account balance that will be deducted from your bank account. The payment amount will be shown in the box labeled “DUE NOW” on your water bill. It will normally be deducted by the 20th day of each month.
\stbwd\billing\eftauthorization
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- hytek medical toledo ohio
- advanced rubber toledo ohio
- toledo public schools staff directory
- toledo ohio school district map
- toledo public schools state grade card
- city of toledo water bill
- department of public utilities toledo ohio
- water bill toledo ohio
- city of toledo water department
- toledo water department
- city of toledo water pay
- toledo dept of public utilities