We offer Bank Drafting for our customers. The process is very simple:

1. Fill out the form below and either submit it online or print it out and mail to us.

2. We will then verify the information by sending a pre-note to your bank

3. 1st month after submitting ACH Bank Draft Form-You will have to pay your bill as usual- Mail-Drop Box, etc.

4. You will receive a statement each month which includes your usage and amount of bill

5. The bottom of bill will state: PAID BY DRAFT

6. Bank draft will be taken from your Bank on the due date reflected on your statement.

We will send statements in advance of the due date to give customers an opportunity to examine their statements and contact our office should they have questions or concerns. All information obtained for ACH Bank Drafts is always confidential and is never sold or given to anyone.

Permission Statement

I (We) hereby authorize Lake Cities Municipal Utility Authority, hereafter called Company, to initiate debt entries for monthly utility payment from my(Our) account, indicated below and the financial institution named below, hereafter call Financial Institution, to debit the same to such account, I (We) acknowledge that the origination of ACH Transactions to My(Our) account must comply with the provisions of U.S. Law.

ACCOUNT INFORMATION

NAME OF FINANCIAL INSTITUTION *

FINANCIAL INSTITUTION BRANCH *

FINANCIAL INSTITUTION ADDRESS *

ROUTING NUMBER *

ACCOUNT NUMBER *

WHAT KIND OF ACCOUNT *

This authority is to remain in full force and effect until company has received written notification from Me(Us) to terminate said authority. Please note that after we receive notice to cancel, it will take a period of time to complete this action with both our records and the financial institution records.

Resident Information

Service Address *

Email Address *

Primary account holder name: By typing your name in space below, you are authorizing LCMUA to draft your bank account for your utility bill each month. *

* +

Secondary Account Holder: By typing your name here, you are authorizing LCMUA to draft your bank account for your utility bill each month

WE WILL NEED A VOIDED CHECK SUBMITTED TO OUR OFFICE BEFORE WE CAN FINALIZE THE PROCESS. YOU CAN SCAN AND FAX OR EMAIL YOUR VOIDED CHECK OR YOU CAN DROP IT OFF AT OUR OFFICE, ALONG WITH YOUR NAME. YOU CAN ALSO MAIL IT TO OUR OFFICE WITH YOUR NAME AND CONFIRMATION NUMBER.

MAIL TO

LCMUA

501 SHADY SHORES DR.

LAKE DALLAS, TEXAS 75065

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