Bank Draft Cancellation Form

Blue Ridge Rural Water will cancel the draft on the date this form is submitted or next business day. Please be sure to submit this form prior to Tuesday of the week the account is scheduled to draft.

Name on the Blue Ridge Rural Water account

First and Last Name *

Email Address: *

Blue Ridge Rural Water Account Number *

I Agree

I authorize Blue Ridge Rural Water Co. Inc. to cancel the bank draft on file with the account listed above and another payment will be used if necessary. I will be required to complete a new bank draft authorization form if I wish to start a bank draft with Blue Ridge Rural Water Co. Inc. in the future. *

Signature: *

clear

Date: * +

Please click submit and you will be redirected to Blue Ridge Rural Water Company's website.

A copy of the completed canellation form will be sent to your email provided for your records.

Thank you for your time.