Skip to main content

Authorization for ACH AutoDraft

* indicates a required field.

Mailing Address same as Service Address
Is this form being completed by a landlord?
Bank Information
Account Type
One file only.
100 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf, doc, docx.

This authorization will remain in full force and effect until Highland Sewer & Water Authority has recevied written notification from me. In order to give Highland Sewer & Water Authority and DEPOSITORY a reasonable opportunity to act, notification must be received no later than 15 days before the next effective transaction date.

By clicking submit you agee to the terms listed above.