AUTHORIZATION TO TERMINATE ACH PAYMENTS
Customer Account Number
Name as it appears on bank account
Checking account number:
Customer contact phone number:
I authorize Jackson County Water Utility, Inc. to terminate collection for my monthly utility bill from the bank account listed above. ACH payment must be terminated five (5) working days before the due date.
Signature (Type your name)
Date (Type today's date ex.. 01/01/2023)