For up-to-date Placer County election results for Lincoln City Council Districts 1 and 2 and Measure F: Lincoln Public Safety & Taxpayer Protection Measure, please visit: https://www.placercountyelections.gov/election-results/

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Cancel Request Form

First and Last Name

Service Address (Street number and name)

City

State

Zip Code

Home Phone Number

Work Phone Number

City of Lincoln Account Number

Bank Name

Checking or Savings Bank Account Number

Email Address

I hereby request the City of Lincoln cancel my participation in the Automatic Bank Draft (ABD) payment plan. I no longer wish to use the bank and bank account number above to pay my monthly utility bills.
I am aware that this form is for cancellation purposes only. If I want to change bank and/or bank account numbers, I will need to fill out a new application.

By signing below, I acknowledge it may take up to thirty (30) days to process my cancellation request once received.

Signature

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Type Name

Date

Forms

Cancel Request Form

I hereby request the City of Lincoln cancel my participation in the Automatic Bank Draft (ABD) payment plan. I no longer wish to use the bank and bank account number above to pay my monthly utility bills.

I am aware that this form is for cancellation purposes only. If I want to change bank and/or bank account numbers, I will need to fill out a new application.

By signing below, I acknowledge it may take up to thirty (30) days to process my cancellation request once received.