*ACH can only be added to an account for continuous scheduled payment once it has a zero balance. This is NOT a single payment service. If you are interested in having your water bill payment automatically deducted from your checking or savings account, please provide the Authority with the following information. This information will be used for billing purposes only: Authorization for Automatic Bill Payment Please Complete ALL Sections and return this form: I authorize the State College Borough Water Authority to instruct my banking/savings institution to make my water (and sewer if located in State College Borough) payment from the account listed below. I understand that I control my payments, and if at any time I decide to discontinue this payment service or if my banking institution or information changes, I will notify the Authority in writing. I understand that the addition or changes to my automatic payment must be made at least 30 days prior to the bill date of the account listed below. I acknowledge that this is not an immediate payment. ACH can only be applied once an account has a 0 balance. I understand that I am responsible for removing ANY other auto-pay that I may have set up. Account Number (required) CID number (required) Name (required) Date (required) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033 Service Address (required) City (required) State (required) Zip Code (required) Telephone Number (required) Email Address Signature In addition to the terms set forth above, the customer shall be subject to all rules and regulations.I have read and agree to the terms and conditions regarding the Automatic Utility Bill Pay with EFT. I authorize the State College Borough Water Authority, to initiate debit entries to my account indicated above. I agree to allow the State College Borough Water Authority to debit my account for my utility billing for corresponding services. This permission will remain in effect until revoked by me in writing. Name for Signature (required) Banking Information (Bank, Savings & Loan, Credit Union) Financial Institution (required) Bank Account Type (required) Checking Savings Bank Account Number (required) Bank Account Number Confirmation (required) Routing Number (required) Routing Number Confirmation (required) Leave this field blank