BANK DRAFT AUTHORIZATION
The Utility Billing Department of the City of Amarillo is hereby authorized to draft on my account 
monthly beginning_________________________.  

  ______________________________                ________________________________
  Utility Customer Name                            Name of Bank  

  ______________________________                ________________________________  
  Service Address                                  Bank Street/PO Address  

  ______________________________                ________________________________  
  Utility Account #                                City State & Zip Code  

  ______________________________                ________________________________  
  Customer Phone #(8:00-5:00 Mon-Fri)              Bank Routing Number  

 ______________________________     ______      ________________________________  
  Customer Signature 	            (Date)         Customer Checking Account #  
  PLEASE ATTACH A VOIDED CHECK/DEPOSIT SLIP TO THIS AUTHORIZATION FORM.      

  IF YOU WANT TO RECEIVE A BILL, PLEASE CHECK HERE _________.