Water Authority-Cayman

Credit Card Standing Order

Customer Instruction Form

Today’s Date:_______________________________________________________

WAC Utility Account Name:________________________________________________

Credit Card Holder/Customer’s Name:____________________________________

Telephone Contact Number:_____________________________________________

 E-mail address________________________________________________________

Credit / Debit Card Number:_____________________________________________

Card Currency:________________________________________________________        

Expiration Date:_______________________________________________________

WAC Utility A/C #_____________________________________________________

Beginning Date:________________________________________________________

Please charge my above Credit / Debit card on a monthly basis for my monthly utility bill. 

 ?         I have attached a copy of my card (front & back) and copy of my driver’s license/photo ID.

______________________________                                    ________________________

Customer’s Signature                                                                WAC Employee Signature

______________________________

Print Customer / Cardholder Name

The above Standing Order may only be cancelled with written instructions from the above named customer or by Water Authority – Cayman due to Card being declined more than 3 times on any one month.