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Automatic Draft ACH Debit Form (Online-Form)

  1. Sign up here to have your water bill payment automatically drafted, monthly, from a checking account. Provide a voided check or a letter from your bank (on their letterhead) showing your name, checking account information including bank routing and checking account number. Attach to the bottom of this form. (We cannot process your ACH form without one of these documents.) Documents must be submitted by the 15th of the month in order for us to process your bank draft for the following month’s bill.

    You will continue to receive a utility bill statement of service. When your account has successfully been set up for automatic draft/ACH debit, your bill will state BANK DRAFT – DO NOT PAY. If your bill does not have this statement, it has not been set up and you must manually pay your bill. Funds will be drafted from your checking account between the 15th – 17th of the month. No additional fees / costs to use our automatic draft/ACH debit option.

    I/we hereby authorize the City of Spring Hill, hereinafter called COMPANY; to initiate debit entries to my/our checking account indicated below at the depository named below, hereinafter called DEPOSITORY, to debit the same to such account.

    COMPANY: Spring Hill Water Works FED ID #: 62-0692693
  2. This authorization is to remain in full force and effect until COMPANY has received a written notification from me/us of its termination in such and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
  3. Attach copy of voided check, or letter from your bank (on their letterhead) here.
    NOTE: All written debit authorizations must provide that the receiver may revoke the authorization only by notifying the originator in the manner specified in the authorization.
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  6. This field is not part of the form submission.