Automatic Payment Plan Authorization AgreementAutomatic Payment Plan Authorization Agreement • December 8th, 2020
AUTOMATIC PAYMENT PLAN AUTHORIZATION AGREEMENTAutomatic Payment Plan Authorization Agreement • December 1st, 2010
Automatic Payment Plan Authorization AgreementAutomatic Payment Plan Authorization Agreement • November 24th, 2021
• Must include a voided check/saving deposit slip or proof of account ownership. (Starter checks are not accepted. The document provided must show the full bank account number and routing number.)
AUTOMATIC PAYMENT PLAN AUTHORIZATION AGREEMENTAutomatic Payment Plan Authorization Agreement • September 12th, 2007
Automatic Payment Plan Authorization AgreementAutomatic Payment Plan Authorization Agreement • January 25th, 2018
Name of your Bank, Savings & Loan, or Credit Union and Routing Number To ensure proper bank coding of your transfer, please ATTACH A CHECK marked “VOID” or provide us with your complete savings, checking, or credit union account number.Note: Participation in the Automatic Payment Plan is contingent upon our receipt of your signed consent to the provision shown on this form. Keep a copy for your records. Savings or Checking Account Number Checking Savings Customer Name (As shown on financial institution records) Address Daytime Telephone No. City State Zip Code Customer Name on Los Alamos County Account Los Alamos County (7 Digit) Account Number (As shown on your bill) Signature. I authorize the named financial institution to make deduction from my account for payment of my Los Alamos County utility and refuse bill. Date:
Automatic Payment Plan Authorization AgreementAutomatic Payment Plan Authorization Agreement • April 5th, 2019
Name of your Bank, Savings & Loan, or Credit Union and Routing Number To ensure proper bank coding of your transfer, please ATTACH A CHECK marked “VOID” or a form provided by your bank or credit union with complete routing and account information shown.Note: Participation in the Automatic Payment Plan is contingent upon our receipt of your signed consent to the provision shown on this form.Keep a copy for your records. Savings or Checking Account Number Checking Savings Customer Name (As shown on financial institution records) Service Address Daytime Telephone No. City State Zip Code Customer Name on Los Alamos County Account Los Alamos County (7 Digit) Account Number and Customer ID number (As shown on your bill) Signature. I authorize the named financial institution to make deduction from my account for payment of my Los Alamos County utility and refuse bill. Date:
AUTOMATIC PAYMENT PLAN AUTHORIZATION AGREEMENTAutomatic Payment Plan Authorization Agreement • November 12th, 2003
Automatic Payment Plan Authorization AgreementAutomatic Payment Plan Authorization Agreement • January 25th, 2018
Name of your Bank, Savings & Loan, or Credit Union and Routing Number To ensure proper bank coding of your transfer, please ATTACH A CHECK marked “VOID” or provide us with your complete savings, checking, or credit union account number.Note: Participation in the Automatic Payment Plan is contingent upon our receipt of your signed consent to the provision shown on this form. Keep a copy for your records. Savings or Checking Account Number Checking Savings Customer Name (As shown on financial institution records) Address Daytime Telephone No. City State Zip Code Customer Name on Los Alamos County Account Los Alamos County (7 Digit) Account Number (As shown on your bill) Signature. I authorize the named financial institution to make deduction from my account for payment of my Los Alamos County utility and refuse bill. Date:
AUTOMATIC PAYMENT PLAN AUTHORIZATION AGREEMENTAutomatic Payment Plan Authorization Agreement • February 26th, 2015
The automatic payment plan allows you to have your monthly utility bill(s) automatically deducted from your bank account (checking or savings).
