Automatic Bank Draft Authorization AgreementAutomatic Bank Draft Authorization Agreement β’ July 13th, 2016
Automatic Bank Draft Authorization Agreement For Payments of City Utility BillsAutomatic Bank Draft Authorization Agreement β’ October 26th, 2012
Automatic Bank Draft Authorization AgreementAutomatic Bank Draft Authorization Agreement β’ August 23rd, 2018
Automatic Bank Draft Authorization AgreementAutomatic Bank Draft Authorization Agreement β’ June 10th, 2019
Please provide the following information. Deduct premium from the following:π Checking Account (Attach a blank, voided check.)π Savings Account (Verify the correct routing number with your bank/financial institution.) Routing #:- Deduct premium on the following basis. (Funds will be transferred on the premium due date.) π Automatic Monthly Premium Payment Requested Start Month Name of bank/financial institution Account number City State ZIP code Member name (please print) Anthem 9-Digit Identification Number (as displayed on ID card) Date of Birth (DOB) Account holder's name Account holder's signature Date
City of Gainesville Automatic Bank Draft Authorization AgreementAutomatic Bank Draft Authorization Agreement β’ March 19th, 2020
AUTOMATIC BANK DRAFT AUTHORIZATION AGREEMENTAutomatic Bank Draft Authorization Agreement β’ July 22nd, 2013
Azalea City Christian School and Child Development CenterAutomatic Bank Draft Authorization Agreement β’ November 4th, 2015
Automatic Bank Draft Authorization AgreementAutomatic Bank Draft Authorization Agreement β’ July 13th, 2016
This authorization will remain in effect until the BVPOA has received written notification from me or my legal representative in such time as to afford the BVPOA a reasonable time to act upon the termination.
Attach voided check or deposit slip here when mailingAutomatic Bank Draft Authorization Agreement β’ June 14th, 2016
Please complete the entire form (all fields are required). For checking account payments, please attach a voided check (not a deposit slip). For savings account payments, please attach a voided deposit slip (if available). Print out, sign and mail this form and the above attachment to:New Mexico Gas CompanyP.O. Box 97500 BC 28Albuquerque, NM 87199-7500 Automatic Bank Draft Authorization AgreementIMPORTANT - Please reviewI authorize the named financial institution to make deductions from my account for payment of my New Mexico Gas Company bill. I understand that I can discontinue participation in the Automatic Bank Draft program by calling the New Mexico Gas Company at the telephone number listed on my bill. I also understand that the monthly withdrawal will take place RQ the due date RI the current bill. Name of your bank, savings and loan, or credit union Routing numberβ 9 digits Routing # Account # Account number Your name(as shown on financial institution records) C
AUTOMATIC BANK DRAFT AUTHORIZATION AGREEMENTAutomatic Bank Draft Authorization Agreement β’ July 12th, 2022
Automatic Bank Draft Authorization Agreement Form Customer Information Customer Name Phone # Mailing Address City, State, Zip Financial Information Name of Financial Institution Routing Number Financial Institution Address Account Number ustomer...Automatic Bank Draft Authorization Agreement β’ July 19th, 2018
AUTOMATIC BANK DRAFT β AUTHORIZATION AGREEMENTAutomatic Bank Draft Authorization Agreement β’ January 9th, 2019
With Automatic Bank Draft, your utility bill is automatically paid through your regular checking account, saving time and expense (provided your account is not on a money order-only basis).
