SAGINAW CHARTER TOWNSHIP WATER DEPARTMENT AUTHORIZATION AGREEMENT FOR AUTOMATIC

SAGINAW CHARTER TOWNSHIP LEASE DISCLOSURE GROWTH OR ACCUMULATION OF
SAGINAW CHARTER TOWNSHIP WATER DEPARTMENT AUTHORIZATION AGREEMENT FOR AUTOMATIC



SAGINAW CHARTER TOWNSHIP WATER DEPARTMENT

SAGINAW CHARTER TOWNSHIP WATER DEPARTMENT

Authorization Agreement for Automatic Bill Payment


I (we) hereby authorize Saginaw Charter Township to initiate debit entries to my (our) CHECKING or SAVINGS account (circle one) and the depository named below, hereinafter called depository, to debit same to such account.


DEPOSITORY/BANK INFORMATION:

DEPOSITORY NAME: _________________________________________________________

CITY & STATE: _______________________________________________________________

ABA/ROUTING NO: ______________________ YOUR ACCOUNT NO: ________________

(9 digits on bottom of check)

This authority is to remain in full force and effect until Saginaw Charter Township and depository has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Saginaw Charter Township and the depository a reasonable opportunity to act on it. I (we) also accept responsibility to notify Saginaw Charter Township in a timely fashion of any changes to the ABA routing number and/or the account number of said account. I (we) accept liability for any bank charges incurred by Saginaw Charter Township as a result of failure to make such notification.


CUSTOMER INFORMATION:

CUSTOMER NAME(S): ________________________________________________________

SERVICE ADDRESS: __________________________________________________________

WATER ACCOUNT #: _________________________________________________________

PHONE NUMBER(S): _________________________________________________________

(necessary if we and/or your depository have any questions about your submitted information)


DATE: _______________________ SIGNED: ______________________________________







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