Direct Debit Authorization Form

City of Mt. Vernon Water Department

A copy of a voided check or a letter from your bank with your account information and your photo ID are required.

By completing and submitting this form, I (we), hereby authorize the City of Mt. Vernon, Mt. Vernon, Illinois, hereinafter called CITY, to initiate credit entries into the City Account at Banterra Bank. These entries will represent payment for water, sewer, and/or garbage services provided by the City. These entries are authorized from my account at the financial institution named below, hereinafter called DEPOSITORY. This debit at my Depository is authorized to the account listed below. Also, if necessary, I authorize the City to initiate any adjusting entries (debits or credits) to correct any error or add any service charges applicable to my (our) account listed below. This authority is to remain in full force and effect until the City has received written notification from me (or either of us) of its termination. Any change to the original debit form needs to be done at least 17 days before the next due date on the water bill.