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By completing this form you <br />authorise ERl1•tU to withdraw' <br />payments from your checking ue <br />savings accounL~"'~ou will continue <br />to receive your utility bill at ]east 14 <br />days before the due date notifying <br />yotl of the charges. Charges will be <br />withdrawn from your checking <br />account on fete due date each month. <br />You MUST att~lch a voided check for <br />checking accounts or a deposit slip <br />for s,•lvings accounts when applying. <br />If Rinds arc not available at the time <br />oP patin-ent, the plan will he canrelMd. <br />Si_t,-~r rrh f~~r rltrs•frec' servlct~ ~In~,• ro flc c~f~ictive~,for• 4~orn• ~nt-t biflr~ts,*• <br />~+~ [~nl}r cotuplete this section if the checking acxount o~clner information is <br />different than the billing infonl~ation on opposite side of this form <br />Customer Nature: <br />Sen~ic~e Address: <br />Cit4~: <br />State: Zip: <br />~g Information below must I~ crnnpteted for application to bz accepted <br />Financial Institution Nanure: <br />T}~pc of Account: Savings Checking (*MUST enclose voided check) <br />CheckingJSati~ings .~eeount Number <br />Financial Institution RoutinglTransit NurnEier; <br />S1gn~ltUlY: <br />Where and How to Make Payments <br />• Mail or hand deliver to our office. <br />• Drop hox options: <br />- office entrance <br />- across from the Post C)ffice <br />• Automatic payment is available upon request. <br />There is a $20 charge for all returned checks. <br />Billing Procedures and Policies <br />iltiliry hills are due on the 15th of each month. <br />date: <br />Elk River Municipal iailities will send a delinquency notice to <br />the customer after the due date has expired and when payment <br />in full has not been received. The notice will state that the hill <br />is past due and services will he disconnected, as specified on <br />the notice. If the bill is not paid or our office is not contacted <br />to have satisfactory arrangements made, no further notice. will <br />he given. <br />There is a 5+'LO reconnection dlarge within normal working; <br />hours of K:00 a.m. to 4:30 p.m., Monday through Friday. '11~e <br />reconnection charge after normal working hours and on week- <br />ends is $100. No reconnections will he done after fi p.m. <br />Elk River .~ <br />Municipal Utilities <br />13tN>~) Orono Yurkway <br />F.II: Rives; A1N 55330 <br />