2. 
   

           Request To Discontinue Bank Draft

4. INSTRUCTIONS

   To discontinue the automatic payment of your utility bill by bank draft each month, complete the information below and submit online with a copy of your drivers license for identity verification. 

6. I hereby request that the City of Bellmead discontinue the drafting of my bank account for the payment of my City utility bill. I understand that I am responsible for the timely payment of my utility bill and that all charges not paid by the due date of the bill shall be considered delinquent and a late charge shall be added to my account. I further understand that failure to pay any bill for City utilities or any portion thereof including delinquent charges may result in termination of my water service.

8. Name*
9. Account #*
11. Service Address*
13. City*
14. State*
15. Zip Code*
17. Date of Final Draft*
19. Signature*
20. Date*
22. Do you agree?*

    1. I agree

    By clicking "I agree" you agree and acknowledge that 1) your application will not be "signed" in the sense of a traditional paper document and 2) by signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.

24. To complete this request, please email a copy of your drivers license to utilitybilling@bellmeadtx.gov. 

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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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