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Consumer Automatic Withdrawal Authorization Form Utility Account Customer Name (as it appears on bank account) Daytime phone Evening Service I authorize the City of Ogden to instruct my financial institution to make my payments. I also understand I may discontinue this authorization at any time by giving written notice to the City Utility Accounting Office. I realize this information will be used solely for the purpose of utility bill payments. Financial Bank Account ( ) checking ( ) savings This authorization must be attached to a voided check Please mail this completed form with your voided check to: Ogden City Utilities 133 W. 29th Street Ogden, UT 84401-3534