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Electronic Payment (ACH) Enrollment Form <br />The City of Santa Ana must be notified of any bank account changes, Failure to notify the City Of such <br />changes may result in your payment being delayed, <br />Keeran lin16n fbayAl <br />-of <br />Add <br />on JIM* Amount: <br />vdHa <br />C, cox 6, n m t o 6 SaiL — tSt,I HOftWcY PO4- <br />7urn -' <br />4— <br />M E Ell E01 K Z�] E E <br />T.p';—dtWIAccount ft-be,X21 Ca;;�06 <br />Tjpt of Account: <br />0 Savings <br />11%6 <br />I confirm the identity of the above-named payee(fl) and the account number and title, As repreventadve of the above-natned <br />Aolancial in4uhlika), A, corUry-Qua. the aarcesAo receive and ctoposit 1ho paynnoro-IftnLiTIOd uIRIVO <br />with 3IMParta 240, 209, and 210, <br />Date; <br />quMV: <br />I Noun or: I <br />p] <br />