La Grange, NC · Lenoir County
Application for Utility Bill Payment by Draft
La Grange utility customers use this application to authorize monthly automatic drafts from a bank account for payment of their utility bill.
What this form is
This application lets a customer authorize the Town of La Grange to draft their bank account on the 15th of each month to pay their monthly utility bill. It asks for the customer’s name, account number, phone number, physical and mailing addresses, and signature and date. The application instructs customers to attach a voided check with the bank account number and routing information.
Who needs it
A La Grange utility customer who wants the town to draft monthly utility bill payments from their bank account should complete this application.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This application is signed and dated without a notary; attach a voided check showing the bank account and routing information.
How to submit this form
- 1
Download The Application
Download the Application for Utility Bill Payment by Draft.
- 2
Complete The Application
Print legibly and provide your name, account number, phone number, physical and mailing addresses.
- 3
Gather The Attachment
Attach a voided check showing the bank account number and bank routing information.
- 4
Sign And Date
Sign and date the application to authorize monthly drafts on the 15th.
Frequently asked questions
- Do I need a notary for the utility bill draft application?
- No. Sign and date the application without a notary, and attach a voided check showing the bank account and routing information.
- How do I submit the utility bill draft application?
- The form does not specify how to submit it. Submit it to the city department named on the form; check the city website for current contact details.
- What information does the application ask for?
- It asks for your name, account number, phone number, physical and mailing addresses, and signature and date.
- What should I attach to the application?
- Attach a voided check containing the bank account number and bank routing information needed for drafting your utility bill payment.