Utility Services
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Credit Card Draft Authorization Form


Customer Information:

Name:

Address:

City:     State:    Zip Code: 

Utility Account Number: 

I authorize the City of Wentzville to process credit card drafts against by credit card listed below:

Credit Card Type:   MasterCard     Visa     Discover     American Express

Card Number:      Card Expiration Date: 

Card Billing Address: 

City:      State:      Zip Code: 

Phone Number: 

Signature:    Date: 

By submitting this form, with your digital signature, you are authorizing the City of Wentzville to process monthly utility payment drafts against the credit card you have provided.

*Effective Feb. 1, 2017, all credit/debit draft transactions will have a 2% surcharge added.


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