Text Box: Vineland Municipal Utilities

Preauthorized Payment Plan Form

John A. Doe 07-91 2649

Jane A. Doe 73-69/839

111 Anywhere Drive

Vineland, NJ 08360

January 1, 2009


ORDER OF Vineland Municipal Utilities覧覧覧覧蘭覧覧覧覧覧覧覧-$ 115.85

One hundred fifteen and 85/100覧覧覧覧覧覧覧覧覧覧覧覧覧覧覧覧覧覧覧覧覧覧蘭覧覧覧覧覧覧覧覧覧覧-DOLLARS


Eagle Security Bank

An ABC Bank 038

Vineland, NJ 08360


MEMO for November優ecember 12345-67890 John A. Doe


Bank痴 ABA Routing Transit Number

Checking Account Number

Check Number





To take advantage of Vineland Municipal Utilities Preauthorized Payment Plan, please fill out the form below and return it with a voided check to Vineland Municipal Utilities, Preauthorized Payment Plan, 640 E. Wood Street, P.O. Box 1508, Vineland, NJ 08362-1508. If you have any questions regarding our Preauthorized Payment Plan, please call our Customer Service Division at (856) 794-4021.


Preauthorized Payment Plan



























Sample Check

Depositor痴 Name as Shown on Bank Records (Print) Checking Account Number

Name of Bank Bank痴 ABA Routing Transit Number

Location of Bank (Street, City, State) Bank Phone Number

Customer Name Customer Address

City, State, Zip Vineland Municipal Utilities Account Number

Phone Numbers:


Home: Work/Cell:

I hereby authorize Vineland Municipal Utilities to automatically debit my bank account monthly under the Preauthorized Payment Plan any Vineland Municipal Utilities bills that are transmitted through the Federal Reserve Bank痴 Electronic Automated Clearing House channels by the Vineland Municipal Utilities. I understand that this agreement may be terminated by me at any time by written notification to Vineland Municipal Utilities. If corrections are necessary, it may result in a debit to my checking account. Credits to my utility account will not result in a deposit of funds to my checking account.

Authorized Signature (As it appears on your bank account) Date