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AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)

Company Name:            Acton Municipal Utility District    
Company ID Number:     1911106                                        

I (We) hereby authorize Acton Municipal Utility District, hereinafter call COMPANY, to initiate entries to my (our) checking account indicated below at the depository financial institution named below, hereinafter called DEPOSITORY, and to debit the same to such account.  I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

Depository Name:  __________________________________________________________________________________________________

Branch:  _________________________________________________________________________________________________

City:  _________________________________________________________________________________________________

State:  _____________________________________________     Zip:  _________________________________

Routing Number:  _________________________________________     Account Number:  _______________________________________

This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

Name (Please Print):  _________________________________________________________________________________________________

Drivers License #:  _______________________________________________________ Drivers License State:  _______________________

Signature:  ___________________________________________________________________________________________________________

 

Name (Please Print):  _________________________________________________________________________________________________

Drivers License #:  _______________________________________________________ Drivers License State:  _______________________

Signature:  ___________________________________________________________________________________________________________

Phone Number:  (_______) _________________________________

Service Address:  ______________________________________________________________________________________________________

Date:  Wednesday, December 26, 2007 01:35 PM

NOTE:  DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION.

Attach Voided Check

and return to:
 
ACTON MUNICIPAL UTILITY DISTRICT
2001 Fall Creek Highway
Granbury, Texas 76049-7927