ACH Form

ELECTRONIC FUND TRANSFER (EFT)
Enrollment Information Form

Please begin the enrollment process for the Electronic Fund Transfer for the following account:

First Name:

Last Name:

Service Address:

City:

State:

Zip Code:

Daytime Phone:

Water Works & Lighting Commission Account Number(s):

I authorize the Water Works & Lighting Commission to instruct my financial institution to deduct my payment from my checking or savings account on the due date of the utility bill I receive. If at any time I decide to change financial institutions or discontinue this payment service, I will notify you at least two weeks prior to payment date.

I have submitted a voided check or entered my financial institution's routing and checking (or savings) account numbers in the spaces provided below.

Deduct My Payment Automatically From:

Checking Account

Savings Account

Name of Financial Institution:

Financial Institution Routing Number:

Checking (or Savings) Account Number:

I am a new Electronic Fund Transfer customer.
I am already an Electronic Fund Transfer customer but wish to use the above information beginning with the next possible due date.

Signature:

Date:

Here is the PDF print version of the form for those who do not wish to fill out the onine application:

Download PDF Version

ACH Form

ELECTRONIC FUND TRANSFER (EFT) Enrollment Information Form

ELECTRONIC FUND TRANSFER (EFT)
Enrollment Information Form