Convenient Payment Option

We now offer Auto-Pay. Your payment is automatically deducted from your bank account. You will still receive your bill, showing in advance the exact amount and date your bank account will be debited. Payment will be verified each month on your bank statement. If you wish to cancel Auto-Pay, simply contact us or fill out this form.

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Auto-pay enrollment form

Auto-Pay Enrollment Form

Name

Address

City

State

ZipCode

Phone Number

I want to take advantage of Auto-Pay I want to take advantage of Auto-Pay Yes. When you choose this option please supply all of the information requested to the right.

I hereby authorize The City of Columbus The City of Columbus to charge my monthly water, sewer and garbage bill electronically to my: I hereby authorize The City of Columbus The City of Columbus to charge my monthly water, sewer and garbage bill electronically to my: Checking Savings at

Bank or Savings Institution

I have enclosed a VOIDED CHECK from my checking account for this purpose. Auto-Pay drafts occur on the following dates. Please check your choice: I have enclosed a VOIDED CHECK from my checking account for this purpose. Auto-Pay drafts occur on the following dates. Please check your choice: 1st 5th 15th

I understand that I may cancel this agreement at any time simply by contacting City Hall at 429-2159. I understand that I may cancel this agreement at any time simply by contacting City Hall at 429-2159.

Authorized Signature

Date

City Account Number

10 + 12 =