Action Center / Authorization for Automatic ACH Bill Payment / Davenport, Iowa

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Authorization for Automatic ACH Bill Payment

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Completing the form below allows the City of Davenport to process your utility bill monthly or quarterly, depending on your billing cycle. Bank account information will be verified using the previous payment account information. A check image or bank letter is not required as long as you have previously paid the City of Davenport using that bank account.

* Denotes a required field

Completing this form allows the City of Davenport to initiate variable payment entries into your account described below. No check image or bank letter is required if you have used the bank account previously to pay your invoice.

Bank Account Type*

Last 4 Numbers of Bank Account*

Financial Institution's Name*

Address*

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

This authority is to remain in full force and effect until the City of Davenport has received written notification of its termination in such time and manner as to afford the city a reasonable opportunity to act on it.

Full Name*

Address*

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

Please Do Not Complete The Following Field

Account Owner's Phone Numer*

Phone Area Code-Phone 3-Phone 4 ext Extension

Utility Account Number*

Utility Customer Number*

By checking the box below, you are giving the City of Davenport the authority to pull funds from your bank account for the amount of your utility bill and verify that all information is correct, complete and you have the authority to grant this access.

I authorize the City of Davenport to use the account information provided above to remit payments for my utility bill.*

Authorizaton

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