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Required Bank Account Documentation

To complete this application, you must provide a voided check with my preprinted name or a bank letterhead that includes applicant's name, bank routing number, and bank account number.

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By submitting this form, I authorize the City of Eldridge to initiate various debit entries to my checking/savings account indicted above and my Financial Institution to debit such account. This authority will remain in full effect until I notify the City of Eldridge in writing of its termination. 

Thank you for your submission

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