Van Horn, TX · Culberson County
Bank Draft Authorization Form
Van Horn utility customers use this form to authorize automatic monthly withdrawals from a checking or savings account to pay their utility bill.
What this form is
This form authorizes the Town of Van Horn to withdraw utility bill payments automatically from a checking or savings account. To enroll, provide customer and utility account details, financial institution information, and bank account and routing numbers, then sign and date the authorization. The form instructs applicants to include a blank check marked “VOID” and explains payment timing, cancellation, and returned drafts.
Who needs it
Van Horn utility customers who want their monthly bill withdrawn automatically from a checking or savings account should complete this authorization.
How to submit it
Return the completed form by fax to 432-283-2839, email to [email protected], regular mail to 1801 West Broadway, P.O. Box 517, Van Horn, Texas 79855, or in person.
About notarization
This authorization is signed and dated without a notary; include a blank check marked “VOID” with the account information.
How to submit this form
- 1
Download The Form
Download the Town of Van Horn Bank Draft Authorization Form.
- 2
Complete The Form
Enter the requested customer, utility account, financial institution, and bank account information, then sign and date the authorization.
- 3
Gather The Check
Include a blank check marked “VOID” with the account information.
- 4
Submit To The Town
Return the form by fax, email, regular mail, or in person using the contact details printed on the form.
Frequently asked questions
- Do I need a notary for the Bank Draft Authorization Form?
- No. The form calls for the bank account holder’s signature and date, not notarization. Include a blank check marked “VOID” with the account information.
- How do I submit the Bank Draft Authorization Form?
- Return it by fax, email, regular mail, or in person. The form lists fax 432-283-2839, [email protected], and the Town’s mailing address.
- What information does the Bank Draft Authorization Form ask for?
- It asks for customer contact and utility account details, the financial institution’s name, and bank account and routing numbers, plus the account holder’s signature and date.
- What should I include with the authorization form?
- The instructions say to provide the account information along with a blank check marked “VOID” to authorize payment from a checking or savings account.