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Direct Payment Form

  1. (Fill in your address)

  2. The authority is to remain in full force and effect until the City has received written notification from me of its termination in such time and manner as to afford the City a reasonable opportunity to act on it.

  3. Submission Instruction

    Attach a voided check and mail your form to:
    City of Blaine
    10801 Town Square Drive NE
    Blaine, MN 55449

  4. Notice

    Automatic withdrawal will take up to one month to take effect. You will see BANK PAYMENT in the upper right corner of your statement once it has been applied to your account. We will draft your account on the last business day of the month in which your statement was sent.

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