Required Bank Account Documentation
To complete this application, you must provide a voided check with my preprinted name or a bank letterhead that includes applicant's name, bank routing number, and bank account number.
Authorization
By submitting this form, I authorize the City of Eldridge to initiate various debit entries to my checking/savings account indicted above and my Financial Institution to debit such account. This authority will remain in full effect until I notify the City of Eldridge in writing of its termination.
Thank you for your submission
