Utility Department

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AUTHORIZATION FOR AUTOPAY PAYMENTS (ACH DEBITS)

By submitting this form, I hereby authorize the City of Venice to initiate debit entries to the account indicated below, and the depository named below, for payment of my utility bill on or after the due date. I understand all changes must be submitted in writing no later than two (2) days prior to the due date of the current bill.
Name of Bank:
Bank Routing Number:
Bank Account Number:
Utility Service Address:
Utility Account Number:
Cycle/Route:
Phone Number:
Requested Effective Date:
Email:
Additional Comments:

This authority is to remain in full force and effect until the City of Venice has written notification from me of its termination in such manner as to afford the City of Venice and the financial institution a reasonable opportunity to act upon it. Debits returned for any reason may incur a $35 charge, in addition to any bank charges. If debits are returned twice, I may be removed from the Autopay program and will be responsible for making other payment arrangements.

PAY YOUR NEXT BILL(S) UNTIL “BANK ACCOUNT DRAFTED FOR” APPEARS ON YOUR UTILITY BILL.