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Bank Draft Authorization

Please fill out the form below and click "Display Form" at the bottom of this page to generate a PDF document that you can print, sign and deliver to our office.

This completed form with my signature below shall serve as authorization for the Inman-Campobello Water District (ICWD) to draft my checking account each month for all bills rendered by the ICWD. The ICWD will draft my checking account 20 days from the date of the cycle bill. I understand this authorization will remain in effect until such time as that I have notified the ICWD to discontinue this service.

I understand that the ICWD may impose a service charge in the event any draft is not paid by my financial institution for a valid reason.

Customer ICWD Account Number
Customer Name on Account
Customer Service Address
Customer Telephone Number
Email Address

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