AutopayAutopayprovidesawaytopayyourCityofLubbockUtilitiesstatementautomaticallyandavoidsthenecessityofwritingandmailingamonthlycheck.Accountholdersareeligibletoparticipateprovidedthat:theyarenotonacash-onlypaymentstatus,theirbankisanaccreditedfinancialinstitutioncapableofacceptingwithdrawalsanddepositsthroughtheAutomatedClearingHouse(ACH)Network,andtheaccountholderhasauthorizedustodebitpaymentsormakeadjustmentsthroughACH.Otherrestrictionsmayapply.

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