Bank Draft Cancellation Form

This form needs to be completely filled out and returned to the Raytown Sewer Department in order for us to cancel your automatic bank draft. Your bank account is drafted on the 10th of every month. In order for your account to discontinue this draft you will need to return this form to the Raytown Sewer Billing Department 15 days prior to the first day of the effective month. Any cancellation request submitted after that date will not go into effect until the next billing period.

Please Print

Customer Name:

Address:

Sewer Account Number

I authorize the Raytown Sewer Department to cancel my automatic bank draft and no longr deduct funds from my checking/saving account to pay my Sewer bill on the 1th of each month.

Signature

Date of request