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AutoPay - Automatic Direct Withdrawal of Water Bill

2. Name*

3. Email Address*

5. Address*

7. City*

8. State*

9. Zip Code*

11. Cell Phone*

12. Home Phone*

14. Date*

15. Water Billing Account Number*

17. Name Bank or Financial Institution*

19. Bank Address*

20. City*

22. State*

23. Zip Code*

25. Bank Routing Number*

26. Bank Account Number*

28. <font color = "#ff0000"><b><font size="6">Allow up to two billing periods for your bank drafting to begin. Please check your account to ensure your paying your balance on time. </font color = "#ff0000"></b></font size="6">

    Allow up to two billing periods for your bank drafting to begin. Please check your account to ensure your paying your balance on time.

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30. Submit

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