Section 1 of 1 in this document
Authorization for ongoing direct payment for utility billing
Applicant information
Name
First Name
*
Last Name
*
Utility account number
*
Service address
Street Address
*
City
*
State
*
Zip
*
Phone Number
*
Email
*
Bank name
*
Routing number
*
Checking account number
*
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Last Name
Email
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I authorize the City of Shoreview to make payments for my utility bill from my bank account as listed above. I agree that ACH transactions I authorize comply with all applicable laws. I understand this process will become effective with the next billing cycle. I will pay any outstanding balance via another form of payment. I understand it is my responsibility to notify the city if I choose to stop the automatic payment service. I will notify the city in writing. The city has the right to cancel my use of this plan if there are issues with collecting payment from this bank account. The city will notify me of the cancellation in writing.
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