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Credit/Debit Authorization Form

  1. I (we) hereby authorize City of Tybee Island to initiate entries to my (our) checking/savings account at the financial institution listed below, and, if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in effect until City of Tybee Island is notified by me (us) in writing to cancel it in such time as to afford City of Tybee Island and the financial institution below a reasonable opportunity to act on it.

  2. By typing your name into this field you authorize the city to consider this an electronic signature.

  3. Please include an original voided check with this form.

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  5. This field is not part of the form submission.