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2. City of Decatur
   Bank Draft Authorization
4. Date*
   Date
6. Name*
7. Account Number
9. Phone Number*
10. Email Address*
12. Service Address*
14. Mailing Address*
    If same as Service Address, please enter "n/a"
18. Please Choose ONE Payment Preference*

    1. Payment from Checking (a voided check Must be submitted)

    1. Payment from Savings (a voided deposit slip MUST be submitted)

    1. Change Account Information (a voided check/deposit slip with new information MUST be submitted)

    1. Stop Payment
20. *Verify with your financial institution, prior to signing this authorization form, that the do participate in bank drafting and determine if there is a bank fee to you for this service.
22. Name of Financial Institute*
24. Address of Financial Institute*
26. Copy of Voided Check/Deposit Slip
    A copy of your voided check/deposit slip is REQUIRED and may be uploaded here, emailed to utilities@decaturtx.org, or submitted in person. We must receive a copy of your voided check/deposit slip BEFORE an ACH Bank Draft is started.
28. Terms and Conditions
    Please check each box to acknowledge that you have read the Terms and Conditions.
30. Terms and Conditions*

    Please check each box to acknowledge that you have read the Terms and Conditions.

    1. You will continue to receive your monthly billing indicating your consumption, amount owed, and due date.
    2. The total amount of your bill is electronically deducted from you checking or savings account each month on the DUE DATE (15th of each month), which appears on your bill.
    3. Your financial institution will list automatic bank drafting payments on their monthly statements to you.
    4. It will take, approximately, one billing cycle before the automatic deduction will occur.
    5. Please continue to pay your bill by cash, check, money order, or credit/debit card until you receive a bill indicating drafting is in effect (notation of "BANK DRAFT/DO NOT PAY").
    6. An NSF fee will be assessed by the City of Decatur for each insufficient funds transfer attempt.
    7. The City of Decatur may terminate your automatic bank drafting service if 2 payment charges are returned for insufficient funds in a 12 month period.
    8. STOP PAYMENT of ACH Bank Draft requests must be submitted 10 business days BEFORE the billing due date.
32. I hereby authorize the City of Decatur to initiate entries to my checking/savings account at the financial institution listed above and, if necessary, initiate adjustments for any transaction credited in error. This authority will remain in effect until the City of Decatur is notified by me, in writing, to cancel it in such time as to afford the financial institution and the City of Decatur to act on it.*

    1. I Agree
34. Digital Signature
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
36. I have read agree to the above Terms and Conditions, confirm that all the information on this application is true and accurate to the best of my knowledge, and authorize the City of Decatur to INITIATE or STOP my ACH Bank Draft as indicated above.*

    1. I Agree
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

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