Save yourself time and money when it comes to paying your monthly water bill. Simply complete this "Bank Draft Authorization Form" and mail or drop off in the night drop or bring by the utility billing office. (One form for each water billing account, if you have multiple accounts)

All INFORMATION PROVIDED IS KEPT COMPLETELY CONFIDENTIAL.

The Town of Little Elm is hereby authorized to draft my bank account, as 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 such time as I provide written notification to the Town of Little Elm Utility Department to cancel this authorization.

Address Of Utility Service:*

Utility Account Number:*

Signature:*

Date:*

(Printed Name)

Phone Number

Name Of Financial Institution:

Branch Location (city)

Checking

Saving

Account Number*

Bank Routing Number (nine digits)*

Please note that you will continue to receive a monthly statement: however, "paid by draft" will appear on your bill.

Be sure to return a voided check with this form.