Automatic Draft Request Form
By checking the box below, I understand and accept that I am requesting for the City of Belmont to automatically deduct my monthly utility bill payment from the bank account that I have provided and I understand and accept that this payment arrangement will continue every month until I request for this to be stopped and canceled. *
By checking the box below, I understand and accept the following terms: My monthly utility bill payment will be automatically deducted from the bank account that I have provided on the 15th of each month. If the 15th falls on a weekend, the payment will be automatically deducted on the following business day. I understand that if the funds are not available on the day that the payment is deducted, I will be charged a $25 returned check fee and will also be responsible for the original payment amount. *
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City of Belmont, NC