Credit Card Draft Authorization Form Credit Card Draft Authorization Form Each individual account must have a separated completed form on file. Due to different bank regulations, it may take approximately two billing cycles to begin automatic billing to your bank account; therefore, it may be necessary to remit your next payment to avoid a late fee. Please contact our office if you have any questions. * indicates a required field Cardholder Name: :* Card #:* Exp. Date* Billing Address:* Address 2:* City:* State:* Zip/Postal Code* Authorized Signature (person authorized to sign on bank account)* Printed Name:* Date Signed:* I authorize RRSD to automatically draft the bank account listed above each month for the amount of my monthly utility bill, including any charges incurred for previous payments, service calls, inspections, meter testing, etc. This will be in effect as soon as possible and will remain in effect until such time as I notify RRSD in writing of my desire to cancel this service, or if RRSD deems termination of drafting necessary. I further understand if I close my account, the final bill may be charged to my checking/savings account before the usual payment due date.