I, the customer, hereby request, authorize and agree that Walden’s Ridge Utility District (WRUD) shall cause payments owed by me to WRUD to be debited electronically from my account, as described below, without my personal written signature. If I fail to have adequate funds in my bank account at the time of the draft, I understand that I will automatically be removed from this plan and the bill plus a service charge will be due immediately. I have the right to cancel my participation in the Bank Draft Plan by notifying WRUD and by giving WRUD and my banking institution a reasonable amount of time to process my request. WRUD and my banking institution reserve the right to end my participation in the Bank Draft Plan. Bills are processed monthly and mailed by the 10th of each month and Bank Drafts will be deducted on the 5th of each month or the next business day.

BANK DRAFT AUTHORIZATION

This completed form must be received in our office by the 1st of the month prior to your billing due date.

Name as shown on your bank account (required)

Name on WRUD account (if different from above)

Your home address (required)

Home (Cell) Telephone (required)

Work Telephone

WRUD Account Number (required)

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

Date (required)

Voided Check or Banking Information (required)

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