Automatic Bank Draft Form

***This form is for changing autodraft setup through Brunswick Regional Water and Sewer H2GO. If you are looking to change your Invoice Cloud autopay, please login to your account on Invoice Cloud or call customer service and specify that you would like to change your Invoice Cloud autopay.***

AUTHORIZATION AGREEMENT ACH PREAUTHORIZED PAYMENTS (DEBITS)

I hereby authorize H2GO to initiate debit entries or such adjusting entries; either debit or credit which is necessary for corrections to my Checking (Y/N) / Savings (Y/N) account indicated below and the financial institution named below to credit or debit the same to such account.

THIS DRAFT WILL OCCUR ON THE 4TH OF EACH MONTH OR THE NEXT BANKING DAY IN EVENT OF A HOLIDAY OR WEEKEND.

In the event of denial by the bank you are responsible for your payment by the 10th of each month.

 

I understand that this authorization will be in effect until I notify H2GO in writing that I no longer desire this service, allowing it reasonable time to act on my notification. I also understand that if corrections in the debit amount are necessary, it may involve an adjustment (credit or debit) to my account.

I have the right to stop payment of a debit entry by notifying my financial institution before the account is charged. If an erroneous debit entry is charged against my account, I have the right to have the amount of the entry credited to my account by my financial institution. I agree to give my financial institution a written notice identifying the entry, stating that it is in error, and requesting credit back to my account. I will provide this written notice within 15 calendar days following the date on which I was sent a statement of my account or a written notice of such entry, or 45 days after posting, whichever comes first.