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Harms Refuse Service. is happy to offer AutoPay as a payment option to our refuse customers.  This feature allows Harms Refuse Service to automatically charge you payment to your checking/savings account each month.  Your payment will automatically be posted to yo8ur account on the 20th of each month.  Please complete the following form and get started today.

 

 

 

CUSTOMER AUTHORIZATION FOR AUTOMATIC WITHDRAWAL

 

Customer Information

 

_________________________________                              _______________________________

Customer Name (Please Print)                                                                            Phone Number

 

 

_________________________________________________

Customer Address

 

 

Banking/Financial Institution Information

 

_________________________________                              _______________________________

Name of Bank/Financial Institution                                                                  Phone Number of Bank

 

 

_________________________________________________                                              _________________________________

Address of Bank                                                                                                  Amount to be debited for transfer

 

 

_________________________________

Routing Number / ABA Number

 

 

_________________________________

Account Number

 

 

 

Authorization

 

I authorize HARMS REFUSE SERVICE, INC. to debit the above amount from the financial institution indicated above for withdrawal from my account.  I understand I may terminate this agreement at any time by completing another Customer Authorization form and sending it to HARMS REFUSE SERVICE, INC. to initiate debit entries and initiate, if named above to debit and/ credit the same such account.

 

 

_________________________________                              ___________________

Customer Signature                                                                                             Date Signed

 

 

Attach a voided check and return form to:                                 HARMS REFUSE SERVICE

                                                                                                2210 No. 98th Street

                                                                                                Lincoln, NE  68505