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Bank Draft Authorization Form

  1. Haslet Logo

  2. BANK DRAFT AUTHORIZATION FORM

  3. City of Haslet Utility Billing Department 101 Main Street Haslet, TX 76052 (817) 439-5931

  4. You must attach a VOIDED Check.

  5. All Information must be completed.

  6. Accounts will be drafted on the due date printed on your utility bill.

  7. I hereby authorize the City of Haslet to debit my checking account monthly for my water utility bill. This authority is to remain in full force and effect until the City of Haslet has received written notification from me of its termination in such time and in such manner as to afford the City of Haslet and the banking institution a reasonable opportunity to act upon it.

  8. PLEASE DEBIT MY ACCOUNT FROM THE BANKING INSTITUTION AND ACCOUNT NUMBER SHOWN BELOW.

  9. Do you wish to donate $1 monthly to the Parks and Recreation Board & Library Board?

  10. Print this form and sign.

  11. NOTE: THIS FORM MUST BE PRINTED, SIGNED, AND SUBMITTED TO THE UTILITY BILLING DEPARTMENT WITH A VOIDED CHECK FOR PROCESSING. MAY BE DROPPED OFF OR MAILED TO THE CITY OF HASLET, 101 MAIN ST., HASLET, TX 76052.

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