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Authorization for Automatic Bank Direct Payment

  1. By submitting this form, I authorize the City of Port Isabel and the financial institution named below to initiate entries to my checking/savings account(s). This authority will remain in effect until I notify the City in writing to cancel it in such time as to afford the financial institution a reasonable opportunity to act on it. I can stop payment of any entry by notifying my financial institution three (3) days before my account is charged. I can have the amount of an erroneous charge immediately credited to my account up to 15 days following issuance of my financial institution statement or 60 days after posting, whichever occurs first. Direct payments will be processed on or after the 15th of each month.
  2. ACCOUNT TYPE*
  3. ACCOUNT TYPE*
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  5. This field is not part of the form submission.