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Authorization Agreement / Termination for Automated Bill Pay

  1. Authorization Agreement / Termination for Automated Bill Pay

    320 Alexandria Boulevard
    Oviedo, FL 32765
    Phone: 407-971-5535
    Fax: 407-971-5806

    Office Hours:
    8 a.m. until 5 p.m.

  2. Instructions

    1. Provide all of the requested information below.
    2. Sign your application.
    3. Attach a VOIDED check from your Financial Institution.

  3. Application Type

  4. A voided check for checking account or deposit slips for savings accounts must be attached. if using a savings account, please verify your routing number and account number directly with your financial institution.

  5. Agreement

    This authority is to remain in full force and effect until the City of Oviedo has received notification from me of its cancellation in such time and such matter as to afford the City of Oviedo and the financial institute a reasonable opportunity to act on it.
    - The City of Oviedo is not responsible for incorrect Routing, or incorrect Account Numbers
    - Please note: When your Automatic Bill Pay withdrawal is active, a message will appear on your Utility Bill stating "Bank Draft - Do Not Pay"

  6. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  7. The City of Oviedo does not accept liability for transmission of this form with confidential information. Email over the internet is NOT a secure medium and privacy cannot be assured.

    Fax: 407-971-5806

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  9. This field is not part of the form submission.