Common Contracts
1 similar Authorization Agreement for Pre-Authorized Payments contracts
ContractAuthorization Agreement for Pre-Authorized Payments • December 18th, 2013
AUTHORIZATION AGREEMENT FOR THE PRE-AUTHORIZED PAYMENTS I (we) hereby authorized the County of Isle of Wight, VA to initiate debit entries for payment of : Real Estate Tax (Customer # or Parcel #) Personal Property (Customer # or PPID#) Utilities - water / sewer (Customer # or Acct #) Stormwater Fees (Customer # or Acct #) to the account and to the financial instituation listed below: NAME OF YOUR FINANCIAL INSTITUTION CITY STATE ACCOUNT # **Important: Please attach a void check to your completed application form.** Debit my bank account as I have indicated below: Monthly $ or on the due date for Real Estate Monthly $ or on the due date for Personal Property Monthly $ or on the due date for Utilities Monthly $ or on the due date for Stormwater All owners of above property must sign. Soc. Sec. # Soc. Sec. # Name Name Signature Signature Daytime Phone Daytime Phone Date Date Email Email This authority is to remain in full force and effect until the C
