Suspend/Cancel Bank Draft Form

Action to be taken:


Reason for suspension or cancellation:

If other please explain:


Name on Account:

Email Address:

Daytime Phone:
() -

CUD Account Number:

Last 4 Digits of CUD Account Holders Social Security Number:

Today's Date:
Now

Effective Date:
Now


THIS REQUEST MUST BE RECEIVED 3 WORKING DAYS PRIOR TO THE BILL DUE DATE
By hitting submit: I herby request Conslidated Utility District to suspend/cancel payment to my account.