ACH Debit Authorization

Cumberland Plateau Water Authority

Debit Authorization

2089 E 1st St. Crossville, TN 38555

Phone 931-484-6987, Fax 931-484-2970

I (we) hereby authorize Cumberland Plateau Water Authority, hereinafter called Company, to initiate debit entries to my (our) account indicated below and the financial institution named below, hereinafter called Financial Institution, to debit the same to such account for my monthly water billing. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

    CheckingSavings

    Date of Debit(s): 15th of every month

    (Note: For varying amounts the company must send, based on the NACHA Operating Rules, written notification of the amount and the date on or after which the transfer will be debited at least ten calendar days in advance of the debit. If the date varies, the Rules state that the Originator must send the Receiver notification of new date at least seven calendar days in advance of the debit.)

    This authority is to remain in full force and effect until Company has received written or verbal notification from me (or either of us) cancelling authorization for bank draft payments, and to terminate in such time and manner as to afford Company and Financial Institution a reasonable opportunity to act on it.