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CITY OF DAHLONEGA 465 RILEY ROAD DAHLONEGA GA 30533 UTILITY BILLING ACH BANK DRAFT REQUEST FORM UTILITY ACCOUNT INFORMATION ACCOUNT NAME SERVICE ADDRESS MAILING ADDRESS PHONE NUMBER BANK ACCOUNT INFORMATION BANK NAME ROUTING NUMBER BANK ACCOUNT NUMBER TYPE OF ACCOUNT CHECKING SAVINGS MONTH FOR DRAFT TO BEGIN I HEREBY AUTHORIZE THE CITY OF DAHLONEGA TO DEBIT MY ACCOUNT AUTOMATICALLY FOR PAYMENT OF MY MONTHLY PUBLIC UTILITIES BILL. THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTIL I NOTIFY THE...

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