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BANK DRAFT AUTHORIZATION FORM <br />Name Account Number <br />Service Address <br />Phone Number <br />City State Zip <br />Email Address <br />I authorize Elk River Municipal Utilities (ERMU) to draft the full amount of my monthly utility bill from the financial institution listed below <br />on the due date of each month (or on the first business day thereafter). I understand that ERMU reserves the right to discontinue my <br />Automatic Bill Payment enrollment in the event a payment is returned. PLEASE BE SURE TO ATTACH A VOIDED CHECK. <br />Financial Institution Routing Number Bank Account Number <br />Account Holder’s Signature Date <br />You can forget worrying about due dates or late fees when <br />you sign up for Automatic Bill Payment. With this service, <br />regular payments will be debited from your bank account <br />on the due date of each month, ensuring your bill will <br />always be paid on time. <br />Automatic Bill Payment is designed to give you: <br />More time. You’ll receive an itemized bill every month but <br />won’t need to take time to schedule the payment. <br />More money. You’ll no longer have the cost (or hassle) of <br />purchasing stamps. <br />More peace of mind. Rest assured, your bill will be taken <br />care of on its due date. <br />Providing our customers <br />more time, more money, and <br />more peace of mind. <br />ERMUMN.COM | 763.441.2020 | 13069 ORONO PARKWAY | PO BOX 430 | ELK RIVER, MN 55330-0430 <br />To enroll: <br /> Complete the Bank Draft Authorization Form below. <br /> Attach a voided check. <br /> Return the form and voided check to our office. <br />AUTOMATIC BILL PAYMENT <br />Sign up and receive <br />a $5.00 bill credit! <br />The one-time bill credit is for new signups only. <br />Recurring payment setup through ERMU’s online <br />bill payment system does not qualify. <br />112