ROWLAND WATER DISTRICT AUTHORIZATION AGREEMENT FOR AUTOMATIC PAYMENT PROCESSING I hereby authorize Rowland Water District and my financial institution to automatically deduct from my checking account indicated below all future payments for my water bills. I understand that both Rowland Water District and my financial institution reserve the right to terminate this authorization and my participation therein. If I choose to terminate this authorization, I will immediately notify Rowland Water District. I understand that authorization will terminate 10 business days after I notify Rowland Water District in writing of my intent to terminate this authorization.

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Why sign up for Automatic Bill Payment? By signing up for our automatic bill payment plan, your monthly water bill will be automatically deducted from the checking account of your choice 14 days after the “date bill mailed” shown on your bill. Will I receive a monthly statement? Your monthly statement will be mailed to you more than two weeks before the payment is deducted from your account. You will be able to review your bill and notify us if you have any questions. If for any reason there is a dispute, you may contact the District prior to the automatic withdrawal date to resolve the dispute before payment is withdrawn. How do I Discontinue Participation in the Program? A written request to the District is necessary to terminate your automatic payment. When will my Automatic Bill Payment Begin? Please pay your current bill in full with a separate check. If your account does not have a zero balance, your first auto- matic payment will be for the entire amount owed. Please continue to pay your bill until “DO NOT REMIT” appears on your monthly statement. Any uncollectible Amounts will be charged a $30.00 Non-sufficient Fund Charge. Additional Deposit may be required.

Consumer Information (As It Appears on your Water Bill)

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Service Address*

Bank Information

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Authorization*
Date
To complete your registration, please upload a voided check below.
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