Automatic Withdrawal Program (ACH)

Authorization Agreement for Preauthorized ACH
Debits/Credits

* – required information

I (we) hereby authorize CRESTVIEW WATER AND SANITATION DISTRICT hereafter called COMPANY, to initiate debit entries to my (our) Checking or Savings account indicated below and the depository named below, hereinafter called DEPOSITORY, to credit and/or debit the same to such account.

Depository Name: Independent Bank

This authority is to remain in full force and effect until COMPANY AND DEPOSITORY has received written notification from me (us) of its termination in such time and in such manner as to afford COMPANY AND DEPOSITORY a reasonable opportunity to act on it.

Manual EntryScanned Check

COMPLETED FORM WITH AN ATTACHED VOIDED CHECK MUST BE RETURNED TO CRESTVIEW WATER & SANITATION DISTRICT BEFORE THE AUTOMATIC WITHDRAWAL PROGRAM CAN BEGIN.

PLEASE NOTE: This transition may take up to 30 days before taking effect.