City Of Golden - Payment Authorization

ADVERTISEMENT

City of Golden
Utility Billing
911 Tenth Street
Golden, CO 80401
(303)384-8026
Are you tired of writing checks to pay your utility bill?
Why not pay it electronically?
It’s fast, easy and doesn’t cost additional fees or service charges.
Here’s how it works: Your quarterly statement is mailed to you at least fifteen (15) days
before the payment is due. The fifteen (15) days gives you ample time to contact us if you
have questions regarding the statement.
Payment will deducted from your checking
account by EFT (electronic funds transfer)on the 30
of the month.
th
The Utility Billing Division is happy to assist you in setting up an EFT agreement. Just
complete the sign-up card below and return it with your current payment. Please contact
us at (303)384-8026 with any questions you may have. The first payment will be deducted
after receipt of your next quarterly utility statement.
------------------------------------------------------------------------------------------------
City of Golden – Payment Authorization
I (we) authorize City of Golden to instruct my financial institution to make my utilities payments from the
account listed below. I may discontinue this automated payment plan by notifying the City of Golden.
Customer Name: __________________________________________________________________
Service Address: _______________________________ Account Number:_________________
Mailing address (
): _______________________________________
if different from service address
______________________________________________ Home Phone: (____)__________________
Banking Information
Financial Institution:_______________________________________________________________
Bank Account Number: _____________________________ checking
savings
SIGNATURE:_______________________________________________________________________
Please enclose a voided check. This is a requirement .

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go