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Bank Draft Form

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Assefa Gebreamlake
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109 views1 page

Bank Draft Form

Uploaded by

Assefa Gebreamlake
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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We Can Make it Easier for You to Pay Your

City of White Oak Utility Bill


 The City of White Oak’s Automatic Payment Plan lets you avoid the inconvenience of writing a check
to the City of White Oak 12 times a year.
 There is no need to send any payment to the City of White Oak, as we will draft the monthly net amount
from your banking institution account and send you, for your records a copy of your utility bill each
month.
 Regardless of where you bank, the City of White Oak makes it easier to take advantage of the convenient
Automatic Payment Plan.
 This is all you do:
1. Sign and return the attached authorization agreement authorizing the City of White Oak to draft
your bank account for water, sewer and garbage service.
2. Attach a voided or canceled check from the bank shown on the authorization and a stub from your
utility bill. Please do not send deposit slips.
 Call the City of White Oak Utility Billing Department if you need additional information.

Automatic Payment Plan Application (APP)


I authorize the City of White Oak to begin deductions from my account with the financial institution
named below in the amount of my monthly utility bill. I understand that I may discontinue enrollment in APP
at any time by sending my request in writing to the City of White Oak Utility Billing Department. I understand
that as an APP customer, I will continue to receive my monthly payment statement for review only. I
understand that both my financial institution and the City of White Oak have the right to terminate this
payment plan or my participation therein. I also understand that the City of White Oak will not reimburse me
for any fees charged by the bank for stop payments, non-sufficient funds, etc.

Name: _______________________________________________
Street Address: _______________________________________________
City/Zip Code: _______________________________________________
Utility Billing Account Number: _______________________________________________
Home Phone Number: _______________________________________________
Work Phone Number: _______________________________________________
Email address _______________________________________________
Financial Institution Name: _______________________________________________
Account Number: _______________________________________________
Financial Institution’s Phone: _______________________________________________
Name(s) Appearing on Account: _______________________________________________
Type of Account: _________ Savings ________ Checking
Signature: ___________________________ Date: __________
Please include a voided or canceled check from the above account.
Once you have completed the application, mail, email, or fax it to:
City of White Oak
906 S. White Oak Road
White Oak, Texas 75693
903-759-3936 (Office) 903-297-3452 (Fax) [email protected]

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