Name (required) Address (required) City (required) State (required) Zip (required) Contact Telephone Number (required) Utility Account Number Social Security Number (required) Valid Drivers License Number (required) Tax I.D. (for business only) I authorize PWSD#2 and/or ECM to process a draft amount against my checking or savings listed below the business day before the due date. - None -Savings AccountChecking Account please select one Bank Name Bank Routing Number Savings Account Number Include a voided check with this form Files must be less than 50 MB.Allowed file types: gif jpg jpeg png. Attach image of voided check (required) Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Signature THIS AUTHORIZATION IS TO REMAIN IN FULL FORCE AND EFFECT UNTIL WRITTEN NOTIFICATION IS RECEIVED TO TERMINATE THIS SERVICE. Leave this field blank