Authorization for ongoing direct payment for utility billing

Applicant information

Utility account number

Phone Number

Bank name

Routing number

Checking account number

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First Name

Last Name

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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.