PAYMENT AUTHORIZATION
CMWCo. Direct Payment Plan Authorization for Pre-Arranged Payments (Debits)
Your Name(please print as shown on bill)________________________________________
(last name)                              (first name)
Consolidated Mutual Water Account Number______________________________
Service Address___________________________________Telephone_________________
City     ___________________             State   _________         ZIP  ________________
Financial Institution_______________________Your Bank Account #_____________
[  ]Checking             [  ]Savings	Please return this form with a voided check. Please print a copy of this form for your records.  ONLY USE ONE FORM PER SERVICE ADDRESS
Signature:_______________________Date:_________
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