Village of Hudson
Water Department
Direct Debit Application
Please attach a voided check or preprinted deposit slip for
verification.
Name __________________________________ Date _____________
Street Address ___________________________ Phone ____________
Water Account # _________
Bank Account # _________________ Checking or Savings? C S
I hereby give The Village of Hudson permission to have my account debited
every month for the amount of my water bill, including garbage and recycling.
________________________________ _____________
Signature Date
Water Department
Direct Debit Application
Please attach a voided check or preprinted deposit slip for
verification.
Name __________________________________ Date _____________
Street Address ___________________________ Phone ____________
Water Account # _________
Bank Account # _________________ Checking or Savings? C S
I hereby give The Village of Hudson permission to have my account debited
every month for the amount of my water bill, including garbage and recycling.
________________________________ _____________
Signature Date