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DPW: Auto Pay Termination

2. 

3. Water Department
   City of Taylor 23555 Goddard Taylor, MI 48180

   City of Taylor 23555 Goddard Taylor, MI 48180

7. Request to Terminate Auto Pay*

   1. I agree

   I hereby authorize the City of Taylor Water Department to terminate my enrollment in the Automatic Payment Plan for my Water Account. I no longer wish to have my water account payments automatically bank drafted from my bank account. I understand that it may take up to another billing cycle to discontinue this service.

9. Water Account Number*

10. Water Account Address*

12. First Name*

13. Last Name*

14. Phone Number*

15. Email Address*

17. Name of Financial Institution*

18. Termination Date*
    Termination Date

20. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. Please review the City's website privacy policy.

    1. I agree.
22. Electronic Signature*

23. Date*
    Date

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