Bank Draft Form

The City of Pendleton offers our customers automatic bank draft service, an easy and convenient way to pay your utility bill. Each month you will continue to receive a bill that includes your usage and dollar amount with "Paid by Draft" at the top of the bill.

The draft will be taken out of your bank account on the due date reflected on your statement.

All fields with an asterisk * are required.

Customer Information

First Name:

Last Name:

Account Number:

Service Address:

Phone Number:

Email Address:

Bank Information

Financial Institution Name:

Financial Institution Address:

City:

State:

Zip:

Routing/Account Information

Routing Number:

Account Number:

Account Type

Checking

Savings

Billing Authorization

I (we) hereby authorize "The City of Pendleton Utility Billing Department" hereinafter called Company, to initiate debit entries for "Monthly Utility Payment" from my (our) account indicated above and financial institution name above, hereinafter called Financial Institution, to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law. This authority is to remain in full force and effect until Company has received written notification from me (or either of us) of its termination in such time and manner as to afford Company and Financial Institution a reasonable opportunity to act on it.

Agreement

I (we) accept the bank drafting / billing authorization agreement.

I would like to receive bills and notices electronically

Yes

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