2. Authorization for Electronic Funds Transfer (EFT)
   For the next billing cycle: I (we) hereby authorize Urbana & Champaign Sanitary District, hereinafter called COMPANY, to initiate debit entries to my (our) account indicated below and the financial institution named below, hereinafter called FINANCIAL INSTITUTION, to debit the same to such account for payment on UCSD bill. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law. This authority 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 manner as to afford COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to act on it. Please allow 30 days for notice of termination.
4. Financial Institution Name
5. City/State of Bank
6. Routing/ABA Number
7. Parcel Account Number
9. Type of Account

   1. Checking

   1. Savings

   Check submitted with payment must match banking info listed.
10. Account Number
12. This must be original signature.
13. Date
15. Phone Number
16. Email Address
17. Email Bill
    Please initial
19. INCLUDE A VOID CHECK OR SOMETHING WE CAN USE TO VERIFY THE BANK ACCOUNT INFORMATION ON THE FORM

    EMail to: info@u-csd.com. 

    Mail or Fax to: Urbana & Champaign Sanitary District PO Box 669 Urbana, IL 61803 Fax: 217-367-2603 

     

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20. Print Only

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