Automatic Bank Draft Service

Required fields are marked with asterisks (*)

Save time and money paying your City of Lincoln Utility Bill

First and Last Name

Service Address (Street Number and Street Name)

City

State

Zip Code

Utility Account Number

Email Address

Home Phone Number

Work Phone Number

Name of Financial Institution

ABA Routing Number

Select the type of bank account

Checking Account

Savings Account

Please attach a voided check from your checking account or documentation from the bank regarding your savings account number

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

I hereby authorize The City of Lincoln to deduct funds from my account at the above indicated financial institution to pay my monthly utility bill. I understand that both The City of Lincoln and my financial institution reserve the right to terminate this payment plan or my participation therein. In addition, I may stop automatic bank draft service by notifying The City of Lincoln in writing. I further understand that if two payments are returned because of insufficient funds within a six month period, my participation in the Automatic Bank Draft (ABD) service may be automatically cancelled. Additionally, payments returned due to insufficient funds are subject to a return check fee of $25.00.

By authorizing The City of Lincoln to deduct funds from my account, I acknowledge that payment of my utility bill remains my sole responsibility. I agree and understand that The City of Lincoln cannot be responsible for any failures of my financial institution to transfer funds, failure of mine to maintain sufficient funds in the paying account, or for any failure of transfer due to problems arising from the Automatic Bank Draft payment service.

Signature

Clear

Type Name

Date