Consent for Automatic Payment:    By signing this consent agreement, the undersigned customer of the City of Bismarck agrees to have his/her monthly municipal services bill deducted from his/her designated checking or savings account. Please complete this form, sign it, attach a voided check and return to the City of Bismarck Water Utility Department.

The City of Bismarck may cancel this automatic billing agreement at any time. I consent to the City of Bismarck billing my checking or savings account directly. If I wish to cancel automatic billing of my checking or savings account, I will notify the City of Bismarck Water Department in writing at least two weeks prior to the next billing date. I understand that there will be a service charge for any payments returned as NSF, and I will be disqualified from the automatic billing plan.