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Phillip Dean Kris Stancil Director of Utilities Commissioner Chairman AUTHORIZATION AGREEMENT FOR BANK DRAFT I(we) hereby authorize Pickens County Water to debit my checking account at the financial institution listed below for payment on my bill. This authorization will remain in effect until I (we) notify Pickens County Water in writing that I (we) no longer desire this service, allowing Pickens County Water and the financial institution 5 business days to act on this notification. Account Name: Address: City, State, Zip: Home Phone: Work/Cell: Financial Institution: Routing Number: Checking Account Number: (This number is located between these symbols I:I on the bottom left of your check) Signature: Date: Draft Date: Please include a voided check and valid driver’s license with the authorization form and mail to: Pickens County Water; 1266 East Church Street; Ste 117; Jasper, GA 30143 or send by email to: [EMAIL REDACTED]. A notice will be printed on your next bill stating PAID BY DRAFT. This statement is for your records. The amount due on the bill will be submitted to the bank on the 2nd of each month and deducted from your checking account on the 5th of each month. If either of these dates fall on a weekend or holiday, they’ll be processed the next business day. It is the customer’s responsibility to notify our office of any changes to the current banking account. To have any changes become effective prior to the bank submission, changes must be submitted to the office prior to the 2nd day of the month. 1266 East Church Street Phone: [PHONE REDACTED] Jasper, GA 30143 Fax: [PHONE REDACTED]