Jefferson, TX · Marion County
Bank Draft Authorization Form
This form authorizes the City of Jefferson to draft monthly utility payments from a bank account for a utility account holder.
What this form is
The City of Jefferson Water/Sewer Department uses this form to authorize monthly bank drafts for utility services. The utility account holder provides account and bank details, signs the authorization, and attaches a voided check. After submitting it, continue paying utility bills until the “Bank Draft — Do Not Pay” note appears on the bill.
Who needs it
A City of Jefferson utility account holder who wants monthly utility payments drafted from a bank account needs to submit this form.
How to submit it
Attach a voided check and return the form to Jefferson City Hall by mail, fax, or in person. Continue paying bills until the “Bank Draft — Do Not Pay” note appears on your utility bill.
About notarization
This form is signed without a notary; attach a voided check, and the account holder signs the authorization.
How to submit this form
- 1
Download The Form
Download the Bank Draft Authorization Form PDF.
- 2
Complete The Form
Fill in your utility account details and bank information, then sign the authorization.
- 3
Attach A Voided Check
Include a voided check with the completed form.
- 4
Return It To City Hall
Return the form to Jefferson City Hall by mail, fax, or in person, and keep paying bills until the bank-draft note appears.
Frequently asked questions
- Do I need a notary for the Bank Draft Authorization Form?
- No. This form is signed without a notary; attach a voided check, and the account holder signs the authorization.
- How do I submit the Bank Draft Authorization Form?
- Attach a voided check and return the completed form to Jefferson City Hall by mail, fax, or in person. Keep paying your bill until the bank-draft note appears.
- What information does the form ask for?
- It asks for utility account and contact details, bank name, account holder name, routing number, account number, and the account holder’s signature.
- Does the city charge a fee for the bank draft plan?
- The form says the City of Jefferson charges no fee for the bank draft plan. It advises checking with your bank about any fee the bank may charge.