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CITY OF LAKE CHARLES WATER DIVISION PHONE 337 491-1307 AUTOMATIC BILL PAYMENT ENROLLMENT FORM SIGN AND MAIL THIS FORM WITH A VOIDED CHECK TO P. O. BOX 1727 LAKE CHARLES LA 70602 With our Bank Draft Program you can enjoy the dependable convenience of Automatic Bill Payment courtesy of the Lake Charles Water Division and your financial institution. It s so simple and you will never have to worry about being late with your payment you will wish you could pay all your bills this way. It s that easy BANK DRAFT AUTHORIZATION I HEREBY AUTHORIZE MY FINANCIAL INSTITUTION TO CHARGE MY ACCOUNT AND REMIT TO LAKE CHARLES WATER DIVISION PAYMENT FOR MY MONTHLY WATER BILLS. Your name as shown on your financial institution account Home address Street Apt City Telephone State ZIP Name of your financial institution Your financial institution account number Name on water bill if different from above Your water division account number Signature as you sign your check Date Please attach a VOIDED CHECK to this form for verification of bank account number. When you see the words Automatic Payment Service on your bill Automatic Billing has taken effect. The City of Lake Charles fully complies with Title VI of the Civil Rights Act of 1964 and related statutes and regulations in all programs and activities. O. BOX 1727 LAKE CHARLES LA 70602 With our Bank Draft Program you can enjoy the dependable convenience of Automatic Bill Payment courtesy of the Lake Charles Water Division and your financial institution. It s so simple and you will never have to worry about being late with your payment you will wish you could pay all your bills this way. Here s how it works You will still get your monthly bill but you will not send your payment through the mail. On the bill s due date the net amount will be deducted automatically from your account and you just subtract that amount from your checkbook. It s that easy BANK DRAFT AUTHORIZATION I HEREBY AUTHORIZE MY FINANCIAL INSTITUTION TO CHARGE MY ACCOUNT AND REMIT TO LAKE CHARLES WATER DIVISION PAYMENT FOR MY MONTHLY WATER BILLS. Your name as shown on your financial institution account Home address Street Apt City Telephone State ZIP Name of your financial institution Your financial institution account number Name on water bill if different from above Your water division account number Signature as you sign your check Date Please attach a VOIDED CHECK to this form for verification of bank account number. CITY OF LAKE CHARLES WATER DIVISION PHONE 337 491-1307 AUTOMATIC BILL PAYMENT ENROLLMENT FORM SIGN AND MAIL THIS FORM WITH A VOIDED CHECK TO P. O. BOX 1727 LAKE CHARLES LA 70602 With our Bank Draft Program you can enjoy the dependable convenience of Automatic Bill Payment courtesy of the Lake Charles Water Division and your financial institution* It s so simple and you will never have to worry about being late with your payment you will wish you could pay all your bills this way. Here s how it works You will still get your monthly bill but you will not send your payment through the mail* On the bill s due date the net amount will be deducted automatically from your account and you just subtract that amount from your checkbook.

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