Autodraft Form

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This field is for validation purposes and should be left unchanged.

Sandhill Account Number(Required)

Name as Shown on Sandhill Account(Required)

First Last

Name of Financial Institution(Required)

Name as Shown on Financial Institution Records(Required)

First Last

Contact Phone Number(Required)

Autodraft from Bank Account or Credit Card(Required)

Bank Account Draft

Credit Card Draft

Bank Account Type(Required)

Checking

Savings

Routing Number(Required)

Account Number(Required)

Credit Card Type(Required)

Discover

MasterCard

Visa

Card Number(Required)

Expiration Date (mm/yy)(Required)

CVV Code(Required)

3 Digit code on back of card

Note: You will continue to receive your bill as normal each month. Allow 1 to 2 billing cycles for draft to begin.

Electronic Signature as Accepted by Financial Institution (Full Name)(Required)