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FORMS

Bank Draft Cancellation Form

DOUGLASVILLE-DOUGLAS COUNTY WATER AND SEWER AUTHORITY

BANK DRAFT CANCELLATION FORM

Customer Name

First

Middle

Last

Customer Account Number

Phone Number

Email

the Number Account

Service Address

Address Line 1

City

State

Zip Code

BANK DETAILS

Type

Name of the Bank

Bank Location

Bank Account Number

Bank Routing Number

Date of Requested Cancellation

Customer Signature

Clear Signature

Today's Date