Bank Draft Cancellation Form

As a convenience to me, I hereby request the Douglasville – Douglas County Water and Sewer Authority (the “Authority”) to cancel the bank draft authorization for the account listed above. I understand that this cancellation will apply only to future debits and will take effect within thirty (30) days after receipt of this form by the Authority and my financial institution identified on this form (the “Bank”). As used in this authorization, “I,” “me,” and “my” mean the customer of record signing this form for the Authority account identified above. By signing below, I understand and acknowledge that bank drafts may continue to occur during the thirty (30) day processing period and that I am responsible for any debits that have already been initiated. I further acknowledge that I am responsible for making arrangements for timely payment of my monthly charges by another method to avoid late fees or interruption of service. In the event I decide to resume bank draft payments, I shall submit a new Bank Draft Authorization form with the required documentation. I agree that this cancellation may be stored electronically and that any electronic copy of this cancellation, including my signature thereto, will be deemed an original, admissible, and enforceable to the same extent as a paper original.