[City of Whitehouse] Utility Bank Draft Authorization Form

Bank Draft Authorization Form

Utility Account Number (if known)

Phone Number

Name of Financial Institution

Address of Financial Institution (Branch, City, State & Zip)

Financial Institution Routing Number

Checking/Savings Account Number

Copy of Voided Check or Deposit Slip

Click Here to Upload

Authorization

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

All account information is considered confidential and is not subject to the Texas Open Records Act.