FORMS

Bank Draft Authorization Form

DOUGLASVILLE-DOUGLAS COUNTY WATER AND SEWER AUTHORITY

BANK DRAFT AUTHORIZATION FORM

Customer Name

First

Middle

Last

Customer Account Number

Phone Number

Service Address

Address Line 1

City

State

Zip Code

BANK DETAILS

Type

Name of the Bank

Bank Location

Bank Account Number

Bank Routing Number

I Authorization information.

Please attach a voided check or a bank account specification sheet to verify your banking information.

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Customer Signature

Clear Signature

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