To begin direct debit of a bank account, complete and sign this form and bring it into our office.

Direct Debit Authorization Form

 I, , the undersigned do hereby give permission to the Rock Rapids Municipal Utilities and their banking institution to debit my checking account for the sole purpose of collecting my monthly utility bill.  I recognize the convenience of this arrangement and have voluntarily provided the information below.

 I understand my account will be debited on the 15^th of each month for the amount of my utility bill, which I will receive in the mail approximately 20 days prior to that date.

 My Bank’s Name:

 My Bank Account Number:     Checking    Savings

 My Bank’s ABA Routing Number:

(the 9 digit number on your checks before your account number between these symbols |: |: or provide the office with a voided check)

 This authorization is valid until revoked by me in writing.

 Name:

 Address:

 Utility Account Number:

 Signature:_______________________________

 Date:

Welcome to Rock Rapids Municipal Utilities 

Your Locally Owned Utility Provider of

Natural Gas, Electricity, Water & Sewer in Rock Rapids, Iowa

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