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Direct Payment Authorization

  1. Storm Lake Jump Right In
  2. Direct Payment Authorization Form
  3. I hereby authorize The City of Storm Lake, hereinafter called "The City" and the financial institution named below, to *

    check one

  4. Street ~ City ~ State ~ Zip Code

  5. This authority is to remain in full force and effect until The City has received written notification from me of its termination in such time and manner as to afford The City and the applicable financial institution a reasonable opportunity to act on it.
  6. City of Storm Lake ~ Utility Billing Department ~ 620 Erie Street ~ Storm Lake, IA 50588 ~ 712-732-8020
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  8. This field is not part of the form submission.