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Authorization Agreement for Direct Payments (ACH Debits)

  1. I (we) hereby authorize City of Weatherford to initiate debit entries to my(our) account indicated below at the Depository named below, and further authorize the Depository to debit the same.
  2. Please select account type*
  3. Name on Bank Account
  4. Important
    First draft will have to pre-note the bank, please allow one full billing cycle for draft to go into effect.
  5. This authorization is to remain in full force and effect until the City has received written notification from me (us) of its termination in such time and in such manner as to afford the City and Depository a reasonable opportunity to act on it.
  6. Leave This Blank:

  7. This field is not part of the form submission.