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P.O. Box 158 - Whitefish, MT 59937 - (406) 863-2457 - Fax: (406) 863-249 Please sign name(s) exactly as you do on your checks Signed: Date: 'DWH NOTE: If the payment draft date falls on the holiday or weekend, your account will be debited on the next business day. The payment amount will vary with the charges in water/sewer consumption. IMPORTANT: PLEASE ENCLOSE A BLANK, VOIDED CHECK SO WE CAN OBTAIN THE NECESSARY ROUTING AND ACCOUNT NUMBERS! ELECTRONIC FUND TRANSFERS CAN ONLY BE MADE WITH BANKS IN THE UNITED STATES! (office use only) Service Address: Account # Route & Meter (/(&7521,&)81'75$16)(53$<0(17²$87+25,=$7,21)250 V