Auto Business Forms by bnr11909

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									                                Automatic Payment Service!
 No more writing checks, buying stamps or standing in line! Your monthly payment can be automatically
 deducted from your checking account.

 If you would like to take advantage of this payment option, please complete this Automatic Payment
 Request form and mail or fax it in with a voided check*.

 Mailing Address: Coachella Valley Water District                   Fax: (760) 398-3190
                  P.O. Box 1058
                  Coachella, CA 92236

 You may discontinue this service at any time by notifying Coachella Valley Water District in writing.
 Questions? Call Customer Service at (760) 391-9600.



 Name on CVWD Account                                 CVWD Account Number



 Service Address                                      City, State, Zip Code



 Daytime Phone/Evening Phone                          Signature/Date

* Automatic Payment Service is only available using checking accounts at U.S. banking institutions.




                               PLACE VOIDED CHECK HERE

								
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