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2. 

4. To begin paying your water bill by electronic fund transfer, directly from your bank account, please complete, print and bring this authorization form to the Clerk's Office at City Hall.  

6. First Name:*
7. Last Name:*
9. House Number:*
10. Street Name:*
11. Street Type:*
12. Apt Number:
14. City:*
15. State:*
16. Zip:*
18. Phone Number:*
19. E-Mail:
21. Bank Name:*
22. City:*
24. Routing Number:*
25. Account Number:*
26. Type of Account:*

    1. Checking
    2. Savings
28. Account Owner Name:*
29. Account Owner Signature:
Leave This Blank:


30. Print Only

* indicates a required field