The City of Deer Park offers an easy and convenient way to pay your water bill. Our Bank Draft service
allows you to have your bill paid automatically by direct deduction from your bank account. Bank Draft
saves you time and ensures that your bill is paid on time, even when you’re out of town. You will
continue to be provided a monthly statement showing your current charges. Because payment is
automatic, there are no late fees or postage costs. This service is provided to you free of charge.

INSTRUCTIONS:
• Complete the authorization form below; to authorize payment from your checking/savings account, provide
account information along with a blank check marked VOID.
• Payments will be deducted from your checking/savings account on the due date or the first business day
following the due date; if we receive insufficient funds notice on bank drafts as unpaid for any reason, you
will be taken off the bank draft program, assessed a $30.00 returned item fee, and can not reapply for 6
months from return item notification.
• The first automatic draft may take up to thirty (30) days from receipt of this authorization form.
• You may cancel this plan at any time by submitting written notice at least (7) days prior to the due date.

Customer Name (as it appears on your bill)*

Account Number (as it appears on your bill)*

Service Address*

Daytime Telephone Number*

Email Address*

Bank Information:

Type of Account*

Checking

Savings

Bank Name*

Bank ABA Routing Number*

Bank Account Number*

Name on Bank Account*

I authorize

I authorize the City of Deer Park to withdraw from the bank account indicated above, my monthly amount
due for utility services. I understand that the City of Deer Park may terminate this automatic payment plan
if the City receives an insufficient fund/returned item bank draft, as well as be assessed a $30 returned
item fee. I also understand that at any time I may elect to discontinue my enrollment in this plan by
submitting a written request at least 7 days prior to the due date.*

Upload Voided Check*

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To ensure the highest level of security regarding your bank information, our preferred method of receiving a voided
check is to deliver it in person to our office or place it in our night drop. We will accept a scanned and emailed, faxed
or mailed version of your voided check; however, you are responsible for contacting the Central Collections Office
to ensure receipt of your information.