Form Center

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
Leave This Blank:


25. Submit Submit and Print

* indicates a required field