Survey/Form Review
Water Services Automatic Bank Draft Application
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Automatic Bank Draft Applicationl
The City of Brentwood provides the feature of paying your water/sewer bill and related charges through automatic bank draft. This eliminates having to write a check each month, as well as the cost of postage or making the trip to our office. The exact amount of your bill is automatically deducted from your checking account on the due date of the billing cycle.
You will continue to receive a water bill each month allowing you to keep your bank account balanced. There will be a memo on your water bill stating the month and day the bank will deduct the amount from your account. A NEW APPLICATION MUST BE COMPLETED SHOULD YOU CHANGE BANKS OR BANK ACCOUNTS!
Please note: The banking information provided below will be encrypted with 128-bit encryption and securely transmitted to the City of Brentwood.
Simple Fields
Please Note: (*) indicates responses are required. |
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| Customer’s Name As Shown On Checking Account: |
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| ABA (Bank Routing Number): |
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| Customer’s Name As Shown on Brentwood Water/Sewer Account: |
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| Address of Water/Sewer Account: |
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| Account ID for Water/Sewer Account: |
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| Daytime Telephone Number: |
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| Electronic Signature:
(By typing your name in the signature box, you authorize the City of Brentwood to automatically draft from your bank account.)
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| What is your email address? Single question: Radiobutton (single) |
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| Please paste your cover letter here Single question >> Radiobutton (single) |
Answer: Plain Text Field - Large >> No validation >> not mandatory
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| Send me your newsletter Boolean field |
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