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2. 
3. Bank Draft Authorization
   Water Bill
5. Banking Information
7. Bank Name*
9. Account Number*
10. 1. Checking
    2. Savings
12. Bank Account Name
14. Routing Number*
16. Driver's License Number*
18. Utility Account Information
20. Account Name*
22. Address*
24. Account Number*
26. Voided Check Upload

    A voided check is required to set up this service for verification purposes. The voided check can be uploaded here or you can submit it to the Utility Services Department by emailing utilities@robinsontexas.org or mailing it or bringing it in person to City Hall located at 111 W Lyndale Dr, Robinson, TX 76706 any time during business hours Monday - Friday between 8 a.m. and 5 p.m. For a list of city observed holiday's visit https://www.robinsontexas.org/652/City-Observed-Holidays. The bank draft will NOT be authorized until the voided check has been received by the Utility Services Department.

28. Authorizing City of Robinson to Draft Account*

    By checking the box below, I authorize the City of Robinson to draft my account as detailed above, on the scheduled due date each month for utility services rendered. I understand that in the event that there are insufficient funds at the time of drafting, it will be treated as an Insufficient Check and an additional fee of $25.00 plus the amount of the draft will be payable within 10 calendar days.

    1. I understand
30. Authorizing Draft of Account to Remain in Effect*

    The authority I give to draft my account will remain in effect until I notify the City of Robinson in writing to terminate the service. Likewise, if I change banking institutions I will notify the City in writing.

    1. I understand
32. Full Name*
33. Date*
    Date
35. Note: All personal information is used solely for bank verification purposes and will be kept strictly confidential
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field