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Water Auto-Draft

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I hereby authorize the City of Pass Christian Water Department to initiate debits for monthly water, sewer, and garbage charges from the checking account indicated below. Accounts will be drafted on or about the 10th of each month. If payment is rejected by your financial institution because of insufficient funds, closed/unauthorized accounts or for any other reason, a return check fee of $40.00 will be applied to your account.

I agree that the signature will be the electronic representation of my signature for all purposes just the same as a pen-and-paper signature. I also agree that my IP address and date will be automatically set within this form. By signing this form electronically and clicking "Submit", you are agreeing to the terms and conditions stated herein.

Bank Check Routing Account Numbers

Scan and upload a voided check. DO NOT write void over the account numbers. 

DEPOSIT SLIP NOT ACCEPTED

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