Automatic Debit Application - City of Alamo Heights

Name*

First Last

Service Address*

Mailing Address (If Different from Service Address)

Home Phone*

Cell Phone

Email*

Please List Water Accounts to be Drafted

Account Number

Account Holder*

First Last

Bank Name*

Bank Address*

Bank Phone*

Routing Number*

Bank Account Number*

Please Attach a Copy of a Voided Check*

Accepted file types: jpg, gif, png, pdf, Max. file size: 3 MB.

Signature*

Email

This field is for validation purposes and should be left unchanged.