Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Bank Draft Authorization

  1. BANK DRAFT AUTHORIZATION

  2. IMPORTANT NOTE: Bank draft will begin after your account has been verified and will take at least one billing cycle to take effect. You will receive a bill with the notation "bank draft" once it begins. You will be responsible for verification of the draft. The draft will be sent to your bank for payment 15 days following the "bill date" noted on your bill. If for any reason the draft needs to be canceled, this request must be submitted five (5) business days prior to the draft date. Any returned payments may result in termination of the bank draft and a service fee will be imposed in accordance with state statutes.

  3. Submit

    Completed forms may be printed and delivered in person at 95 Triplet Lake Drive, Casselberry, FL 32707

  4. Email Notice

    Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

  5. Please type exactly as it appears on monthly invoice

  6. Name on Utility and Bank Accounts must match

  7. Please include area code

  8. Under Florida law, e-mail addresses are public records.

  9. Service Address

  10. Please enter the information below very carefully. The bank can help provide this data.

  11. This is a 9 digit number

  12. Type of Account*

  13. Signature

  14. I, the undersigned, authorize the City of Casselberry Utility Division to send my utility bill to the above bank from direct payment for my account. I understand my account will be bank drafted every month on my posted due date. I understand that it is my responsibility to ensure payment is successfully drafted each month.

  15. Leave This Blank: