Bank Drafting Form

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The City of Corinth offers our customers automatic bank draft service, an easy and convenient way to pay your utility bill. Each month you will continue to receive a bill that includes your usage and dollar amount with "Paid by Draft" at the bottom of the bill.

The draft will be taken out of your bank account on the due date reflected on your statement.
All customers signing up for bank draft will automatically be signed up for electronic billing.
Due to the verification process, please continue to submit payments until you receive a statement marked "Paid by Draft".
If payment is not submitted during the verification process, late fees could be incurred.

Customer Information

Last Name: *

First Name: *

Secondary Customer Name:

Phone: *

Service Address *

City *

State *

Zip *

Email Address *

Bank Information

Financial Institution Name: *

Branch

Financial Institution Address

City

State

Zip

Routing Information

Routing Number: *

Account Number: *

Account Type: *

Checking

Savings

Billing Authorization

I (we) hereby authorize "The City of Corinth Utility Billing Department" hereinafter called Company, to initiate debit entries for "Monthly Utility Payment" from my (our) account indicated above and financial institution name above, hereinafter called 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. This authority is to remain in full force and effect until Company has received written notification from me (or either of us) of its termination in such time and manner as to afford Company and Financial Institution a reasonable opportunity to act on it.
I hereby authorize the City of Corinth Utility Billing Department to initiate electronic utility bills via e-mail for the account listed above. I acknowledge that it is my responsibility to notify the City of any changes in email addresses. Failure to receive a statement or update e-mail addresses does not exempt me from the responsibility to make payment. I understand that by approving this service I will no longer receive a mailed statement.

Agreement *

I (we) accept the bank drafting / billing authorization agreement and to receive electronic bills via email.

Receive an email copy of this form.