Skip to Main Content
Loading
Loading
EMERGENCY ALERT
OUTDOOR WATER RESTRICTIONS UNTIL FURTHER NOTICE
Read On...
Create a Website Account
- Manage notification subscriptions, save form progress and more.
Website Sign In
Government
Departments
City Services
About Us
Home
Forms
Automatic Bank Draft Form
Leave This Blank:
Account Number:
I (We) hereby authorize the City of McCook, hereinafter called COMPANY, to initiate debit entries to my (our) bank account indicated below at the depository financial institution named below, hereinafter called DEPOSITORY, and to debit the same to such account. I (We) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of the United State Law.
DEPOSITORY ACCOUNT HOLDER INFORMATION
Start Date:
*
Name:
*
Address:
*
Phone:
*
DEPOSITORY ACCOUNT INFORMATION
Bank Name:
*
Branch:
City:
State:
Zip:
Routing Number:
*
Account Number:
*
This authorization is to retain in full and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
Electronic signature:
*
NOTE: All written debit authorizations MUST provide that the receiver may revoke the Authorization only by notifying the originator in the manner specified in the Authorization.
ATTACH VOIDED CHECK
*
Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)
* indicates required fields.
Live Edit
Home
How do I...?
Pay My Water Bill
City of McCook GIS
Bid Postings
E-Services
Archive Center
Bids
Calendar
Carbon Calculator
Document Center
Facilities
FAQs
Jobs
News Flash
Notify Me
Online Forms
Opinion Poll
Pay Utility Bill Online
Photo Gallery
Quick Links
Real Estate Locator
Request Tracker
Staff Directory
Annual CCR Report
Next Generation Cost-Benefit Analysis
Job Postings - City of McCook
Job Postings - SW Nebraska
Municipal Code
Building & Zoning
Agendas & Minutes
Go-To McCook
Strategic Planning
Topic for Consideration for Council Agenda
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow