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Draft Authorization Form

  1. The City of Bullard will draft your bank account monthly upon submission of this form. I understand that the first draft will begin with the second billing after timely receipt of this form. I hereby authorize the Cit of Bullard to withdraw a draft from my bank account listed below on a monthly basis for services rendered, and if necessary, initiate for any transaction debited or credited in any error. This authority will remain in effect until the City of Bullard is notified by me in writing, to cancel and until the City of Bullard has reasonable time to make that change. I agree that the City of Bullard will charge an NSF fee of $30.00 and other possible penalties. Initiation or cancellation of this service may take up to 60 days. Until I receive a bill marked 'PAID BY DRAFT' I am responsible for payment on my own initiative. All drafts will be processed for payment on the 17th of each month.
  2. Utility Account Information
  3. If different from above.
  4. Bank Account Information
  5. Account Type
  6. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  7. Leave This Blank:

  8. This field is not part of the form submission.