Valparaiso City Utilities

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Direct Debit Cancellation Form
I (we) request that the Valparaiso City Utilities cancel my (our) Automatic Bank Payment Service. I understand that an ACH transmission can be sent up to 7 days before my due date and that it is possible that this may not take effect until my next billing cycle.

Name
Date (mm-dd-yyyy)
Address of Account
VCU Account Number
Customers Bank
Effective Date (mm-dd-yyyy)
Reason For Cancellation
Comments


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