This form authorizes Mallory Valley Utility District to draft your checking account for payment.
A billing statement will be mailed to you around the tenth (10th) of each month.
Payment by bank draft will begin on the next Full Billing Cycle.
The amount is then drafted from your account on the first (1st) of the following month.
1. Please complete this form and attach a voided check
from the account to be drafted.
2. If the account is a joint account, both parties must sign the bank draft authorization.
3. Payment of your bill by bank draft will begin the next billing cycle.
4. If you have any questions, please call the District office at 615-628-0237.
5. You can email the form and voided check to [email protected]
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