colu-bank draft authorization · pdf file · 2017-12-11ifhe t utomatia c...

Autopay Autopay provides a way to pay your City of Lubbock Utilities statement automatically and avoids the necessity of writing and mailing a monthly check. Account holders are eligible to participate provided that: they are not on a cash-only payment status, their bank is an accredited financial institution capable of accepting withdrawals and deposits through the Automated Clearing House (ACH) Network, and the account holder has authorized us to debit payments or make adjustments through ACH. Other restrictions may apply. To begin using Autopay, please complete and detach the Direct Debit Authorization Form below, attach a voided check or bank document showing the bank name, routing number and account number to be used for ACH entries, and mail both to City of Lubbock Utilities, PO Box 10541, Lubbock, TX 79408-3541. Please allow four weeks for application processing. Participation in Autopay does not affect your obligation to pay your statement in full when due. Protest of your statement or Autopay cancellations must be communicated to us by calling (806) 775-2509 at least four business days prior to the date of automatic withdrawal shown on the statement. If the automatic transaction is not honored by the financial institution, we may attempt to process your payment one additional time within the 30-day billing period. For each returned item, the account holder is responsible for all returned item or late payment fees imposed by City of Lubbock Utilities and your financial institution. Once enrolled, the date of funds withdrawal will be identified on your statement, and your statement will include a “Do Not Pay” notice reminding you that your payment is automatic. For more information call (806) 775-2509 or visit our website at CityofLubbockUtilities.com. Easy. Quick. Convenient. Autopay! Detach and return bottom with voided check or bank document indicating routing and account number to be used for ACH entries. Direct Debit Authorization Form – I authorizeCityof Lubbock Utilities to withdraw from my bank account the fullamount of the “Balance Due” as shown on my monthly statement, via the ACH Network on or after the “Due Date” date specified on the statement. I also authorize City of Lubbock Utilities to reverse transactions, or makedeposits into my account, through the ACH Network in the event a correction to the amount withdrawn is necessary. Name as it appears on bank account o Personal Account o Business Account Name of financial institution Routing number Bank account number o Checking Account o Savings Account Signature (please use your usual bank signature) City of Lubbock Utilities Account Name Daytime phone # City of Lubbock Utilities Account Number (14-digits) Date

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Page 1: COLU-Bank Draft Authorization · PDF file · 2017-12-11Ifhe t utomatia c transactionsi otn onoredh by the financialnstitution, i weyma ttempta to processoury ymentpa ne o dditionala

TobeginusingAutopay,pleasecompleteanddetachtheDirectDebitAuthorizationFormbelow,attachavoidedcheckorbankdocumentshowingthebankname,routingnumberandaccountnumbertobeusedforACHentries,andmailbothtoCityofLubbockUtilities,POBox10541,Lubbock,TX79408-3541.Pleaseallowfourweeksforapplicationprocessing.ParticipationinAutopaydoesnotaffectyourobligationtopayyourstatementinfullwhendue.

ProtestofyourstatementorAutopaycancellationsmustbecommunicatedtousbycalling(806) 775-2509atleastfourbusinessdayspriortothedateofautomaticwithdrawalshown onthestatement.

Iftheautomatictransactionisnothonoredbythefinancialinstitution,wemayattempttoprocessyourpaymentoneadditionaltimewithinthe30-daybillingperiod.Foreachreturneditem,theaccountholderisresponsibleforallreturneditemorlatepaymentfeesimposedbyCityofLubbockUtilitiesandyourfinancialinstitution.

Onceenrolled,thedateoffundswithdrawalwillbeidentifiedonyourstatement,andyourstatementwillincludea“DoNotPay”noticeremindingyouthatyourpaymentisautomatic.

Formoreinformationcall(806)775-2509orvisitourwebsiteatCityofLubbockUtilities.com.

Easy.Quick.

Convenient.Autopay!

DetachandreturnbottomwithvoidedcheckorbankdocumentindicatingroutingandaccountnumbertobeusedforACHentries.DirectDebitAuthorizationForm–IauthorizeCityofLubbockUtilitiestowithdrawfrommybankaccountthefullamountofthe“BalanceDue”asshownonmymonthlystatement,via theACHNetworkonorafterthe“DueDate”datespecifiedonthestatement.I alsoauthorizeCityofLubbock Utilitiestoreversetransactions,ormakedepositsintomyaccount,through theACHNetworkintheeventacorrectiontotheamountwithdrawn is necessary.

Nameasitappearsonbankaccount

o PersonalAccountoBusinessAccountNameoffinancialinstitution

Routingnumber Bankaccountnumber

o CheckingAccountoSavingsAccount

Signature(pleaseuseyourusualbanksignature)

CityofLubbockUtilitiesAccountName Daytimephone#

CityofLubbockUtilitiesAccountNumber(14-digits) Date

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