Autopay Signup

If you would prefer to print out and complete a print copy of this application, please go to the printable Autopay form

Company Name: Highland Sewer and Water Authority
Company Tax ID: #25-6008982

I authorize Highland Sewer and Water Authority, hereinafter called COMPANY, to initiate debit entries to my account (select one above) indicated below at the depository financial institution named below, hereinafter called DEPOSITORY.  Also, if necessary, initiate adjustments for any transactions debited in error.

Notice

This authorization will remain in force and effect until COMPANY has received written notification from me of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

Please include dashes.

By checking this box, I agree and affirm that all the information entered on this form is correct and complete to the best of my knowledge.

 

Note

In the case of revoked authorization, all written authorizations must be revoked only by notifying the originator (COMPANY) in writing no later than 15 days before the next transaction effective date.