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4. Information

   Save yourself time and money when it comes to paying your monthly water bill. Simply complete this Bank Draft Authorization Form and return it by mail, drop in the Night Drop Box, or to the Utility Billing Office during regular business hours with a voided check.  
   
   One form required per account, if you have multiple accounts. 

   Note: You will continue to receive a monthly statement; however, "Paid by draft" will appear on your bill. 
   
   All information is kept confidential. 

6. Authorization

   The Town of Little Elm is hereby authorized to draft my bank account listed below on the due date of each month for my monthly water bill. I understand that my account will be paid by draft until I provide written notification to the Town of Little Elm Utility Department to cancel this authorization. 

   1. Yes
   2. No
8. Address of Utility Service:
10. Street Number
11. Street Name
12. Street Type
13. Apt #
15. City
16. State
17. Zip
19. Utility Account Number:
21. Name on the Utility Account:
22. Phone Number:
24. Date:
    Date:
26. Name of Financial Institution:
27. Branch Location:
29. Type of Account:

    1. Checking
    2. Savings
30. Account Number:
31. 9-Digit Bank Routing Number:
35. To Print

    To print this form, complete the fields and hit Control+P. 

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36. Print Only

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