WATER DEPARTMENT-ACH ENROLLMENT

FOLLOW THE 4 EASY STEPS TO SETTING UP DIRECT PAYMENT ON YOUR WATER/SEWER BILL

  1. Complete the contact information requested below (please print):

Name: ______

Service Address: ______

Mailing Address: ______

Daytime Phone: ______

Water Billing Account Number: ______

  1. Provide your signature for authorization:I authorize the City of Linden to deduct my water utility billing payments from my checking or savings account listed below. The date it will be deducted will be the 25th of each quarterly billing period. I understand that I control my payments and if at any time I decided to discontinue this service, I will notify the city of Linden in writing. I also understand that all information here will remain confidential. If there is a NSF I understand it will be an additional fee of $25.00

THIS FORM CANNOT BE PROCESSED WITHOUT YOUR SIGNATURE.

Signature: ______Date: ______

  1. Provide the required financial information below:

To endure the correct account number is used for this electronic payment and to obtain the ABA/routing number, please contact your financial institute for assistance.

Name of Financial Institute ______

ABA/Routing Number: ______

Account # ______

What type of account (circle one) Checking or Savings

  1. PLEASE RETURN THE ORIGINAL WITH A VOIDED CHECK TO:

CITY OF LINDEN

ATTN: BEV VONDRA

P O BOX 507

LINDEN, MI 48451

ACH ENROLLMENT PROGRAM

Dear Resident:

On the reverse of this letter there is an enrollment form for the ACH program for your utility bill. We only offer this for your utility bill NOT your tax payments. There is no fee to you to use the ACH program.

If you wish to continue to use the Point and Pay process there is still the 3%fee of your bill that will be charged to you.

If you wish to enroll in this program, please fill out the reverse side of this form and return it to the address listed.

If you have any questions, please contact Sue or Bev at 810-735-7980

Hours of operation:

Monday – Thursday 8:00 am to 5:00 pm. closed for lunch 12:30pm to 1:30pm

Friday 8:00 am. To 1:00pm

Beverly J. Vondra

City of Linden

Treasurer