Bank Draft

Boaz Gas Board has the bank draft option for paying your monthly bill. If you wish to use this service, please fill out the bottom portion of this letter and return it to our office. Your monthly gas bill will automatically be paid by bank draft each month. You will receive a bill in the mail; however, the bill will read “DO NOT PAY, SCHEDULED FOR BANK DRAFT”. If you have any questions, please do not hesitate to give us a call.

Name *

Service Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Phone *

Name of Bank *

Name As Shown On Bank Records *

Routing # *

Checking Account # *

Authorization *

I hereby authorize Boaz Gas Board to draw a monthly draft on my account for payment of gas billing.  

Signature *

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Date

Drivers License *

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Copy of Check or Deposit Slip with Routing and Account Number *

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