Town of Darmstadt Authorization for Sewer Bill Autopay

Complete the authorization form to enroll in autopay for timely, hassle-free payment of your monthly Darmstadt Sewer bill. All transactions are securely processed.

In lieu of a voided check or deposit slip, by clicking agree, it signifies verification that you provided your correct routing number and bank account number.

***PLEASE NOTE***
There will be a $20.00 charge for all returns.

After 3 returns, your Direct Debit Agreement will be terminated.

ACH Form

Bank Information

Bank Name(Required)

Routing Number(Required)

Bank Account Number(Required)

Account Type(Required)

Checking

Savings

Personal Information

This authority is to remain in full force and effect until DARMSTADT TOWN SEWER has received written or verbal notification from me of its termination and in such manner as to afford DARMSTADT TOWN SEWER AND BANK DEPOSITORY a reasonable opportunity to act on it.

Name(Required)

First Last

Phone(Required)

Email(Required)

Service Address(Required)

Street Address Address Line 2 Town (DARMSTADT) State ZIP Code

Account Number(s) NOT REQUIRED

Signature

I would like to sign up for ACH Autopay billing, which will run MONTHLY On or AFTER the 10th of the month. Please note autopay deductions completed by Old National Bank, after the 10th of the month are not considered late. Autopays are considered on time as long as you signed up the month before. If you are submitting this autopay request, close to the 10th of the month, you may want to pay the current amount due, in your usual manner to give autopay time to be submitted to the bank and active for your account.(Required)

Yes

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ALL NEW! Sign up for Sewer Bill Autopay

Town of Darmstadt Authorization for Sewer Bill Autopay

ACH Form

Bank Information

Personal Information

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