Direct Debit Authorization Form
City of Port Lavaca Utility Billing
Thank you for your interest in our Direct Debit Program! Direct Debit allows us to automatically take payment of your monthly water bill directly from your bank account. It is a convenient way to pay your water bill each month. Here is how the program works:
- Each month, your regular bill will be sent to you showing your water usage, balance due and due date.
- On the due date of the bill, the balance due shown on the bill will be automatically withdrawn from your designated bank account.
To begin the Direct Debit Program, simply fill out the information requested below and drop off or mail to City of Port Lavaca, 202 N. Virginia St., Port Lavaca, TX 77979. Please be sure to enclose a VOIDED check or copy of your Bank Member ID card that displays your name, routing number and account number in order to verify the banking information.
You should continue to pay your bill as usual until you receive a statement confirming the amount and date that your first draft will be withdrawn. It can take up to a full month for the draft to go into effect, so be prepared to pay your upcoming bill manually.
We appreciate your interest in the Direct Debit Program and hope it makes paying your water bill a little easier each month. If you have additional questions about this program, please call our Customer Service Department at (361) 552-9793 extensions 238 & 239.
I authorize the City of Port Lavaca to withdraw funds necessary to satisfy the amount due on my water bill from the following Financial Institution:
Bank_____________________________Account#________________________Date_________
Routing Transit Number____________________________ Signature______________________
Please enclose a voided check or a copy of your Bank Member ID card from the account you want your monthly payments to be deducted from. (Please verify accuracy of the information submitted before signing.)
Customer’s Address:_____________________________________________________________
Customer’s Name:_______________________________________________________________
Customer’s Water Account:_______________________________________________________
Customer’s Current Phone Number:_________________________________________________
Direct Debit Authorization Form
