I/ We authorize Valley Center Municipal Water District (VCMWD) to initiate debit entries to my/our
( ) Checking
( ) Savings
Account (select one) indicated below at the financial institution (Depository) named below, and to debit the same to such
account.(Include a voided check or deposit slip with authorization)
Depository
Branch
Routing Number
(9 digit number at bottom of your check or deposit slip)
Depository Acct#
Name(s)
VCMWD Acct#
Signed ______________________________________________
Date
After completing the form, print it, sign, and mail with your voided check or deposit slip to
VCMWD, PO Box 67, Valley Center, CA 92082.
(To print, choose File->Print from the menu at the top of your browser.)
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