Bank Draft Cancellation Form

By Submitting This Form You Are Authorizing Lake Cities Municipal Utility Authority To STOP Using The Current Bank Account Information On File To Draft Monthly Payments For Your Billing Statement.

SERVICE ADDRESS *

ACCOUNT NUMBER *

EFFECTIVE DATE OF CANCELLATION * +

PRIMARY NAME ON ACCOUNT *

SECONDARY ACCOUNT HOLDER *

BY TYPING YOUR NAME IN BOX BELOW YOU ARE AUTHORIZING LAKE CITIES MUNICIPAL UTILITY AUTHORITY TO CANCEL YOUR BANK DRAFT PAYMENTS FOR YOUR BILLING STATEMENT.

PRIMARY ACCOUNT HOLDER TYPED NAME *

SECONDARY ACCOUNT HOLDER TYPED NAME

WE WILL SEND AN EMAIL CONFIRMING THIS CANCELLATION.

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