Instructions:
· Return this completed form (signed and dated) to Bank of Utica Checking Account Department,
222 Genesee Street, Utica, NY 13502-4385 or fax to 797-2707.
· You will receive an e-mail confirming your enrollment.
Please Print:
First Name Last Name
Street Address
City State ZIP
Email address (valid address required) Telephone
Checking/Money Market Acct.# Statement Savings Acct. #
Bank of Utica Accounts you may want to use for bill-paying (You can use more than one account). For personal accounts only.
If using a Money Market or savings account, federal regulations allow you to make up to six transfers (i.e. pay 6 bills) per month. If using a checking account, you can pay an unlimited number of bills. See online terms and conditions for more details.
ENROLL ME IN ON-LINE BILL PAYING! By signing this form, I authorize Bank of Utica to debit my account listed above and to make payments on my behalf as periodically initiated by me.
The authorization provided in this form will remain in full force and effect unless and until Bank of Utica actually receives written notice from me to discontinue bill paying and has a reasonable opportunity to act on such notice. The notice must be directed to Bank of Utica Checking Account Department, 222 Genesee St., Utica, NY 13502-4385, Telephone (315) 797- 2761. For joint accounts, a notice received from either signer will be considered authorization to suspend bill paying access. I understand that I must set up payments to be made 5 to 7 days before their due date.
Signature (if your account requires two signatures for withdrawals, then both parties must sign)
Date