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Automatic Bank Draft Authorization

  2. Authorization
    I hereby authorize Sun 'n Lake Improvement District to initiate debit entries (and if necessary, credit entries and adjustments for any debit entries in error) to my account(s) listed below. I also authorize the Financial Institution named below to debit and credit the same entries to such account(s).
  3. (if applicable)
  4. Financial Insitution
  5. Financial Institution
  6. Financial Institution
  7. This is usually located at the lower left hand corner of you check.
  8. As shown on bill
  9. Would you like to add another Utility Account?*
  10. This authority is to remain in full force and in effect until the Sun 'n Lake Improvement District has received written notification from me of it's termination, in such time and such manner as to afford Sun 'n Lake Improvement District and the Financial Institution a reasonable opportunity to act on it. I understand that failure to ensure sufficient funds to cover the debit of my account for the amount listed on my utility bill can result in additional charges to my utility account, and Sun 'n Lake Improvement District may terminate my utility services in such circumstances.
  11. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  12. Leave This Blank:

  13. This field is not part of the form submission.