Is your Mailing Address the same as the Service Address?
Bank Account Number*
Bank Routing Number*
Upload a copy of a voided check or deposit slip. (PNG and JPG allowed, 8mb limit)
I, the above named applicant, hereby authorize the City of Goodland, to submit my monthly utility billing to the named establishments for automatic withdrawal and understand that at any time I may cancel this agreement upon notification to the City of Goodland. Please attach copy of a voided check or deposit slip to form or drop by the City Office at 204 W. 11th St..