Revised 3/8/18
Airport SUREPAY Form
You can authorize the City of Chandler and your bank to automatically pay your Hangar, Tie-down or
T-shade Rent using SUREPAY. SUREPAY is a payment method that automatically withdraws the funds
from your bank account to pay for your City bill. The City bill amount will be deducted from your checking
account on the 1st business day of the month. Sign up by completing and returning the form below. If
you need more information, please call Accounts Receivable at 480-782-2326.
Forms returned on or before the 15th of the month will have the next Hangar, Tie-down or
T-shade Rent, due the 1st business day of the following month, deducted from your account.
Airport SUREPAY Authorization for Automatic Payment
Mailing Address Location Address
Mail Stop 702 4th Floor
P.O. Box 4008 175 S. Arizona Ave.
Chandler, AZ 85244-4008 Chandler, AZ 85225
I hereby authorize the City of Chandler to initiate automatic charges to my bank account
indicated below for payment of my City bill.
Customer Name: Customer Account #:
Address:
Financial Institution Name:
Bank Account #: Checking or Savings
Bank Branch Telephone #:
Authorized Customer Signature:
Date: Telephone #:
* You must attach a check marked “void” from your bank account for verification purposes.
Go Paperless
If you would like to go "paperless" and have your monthly statement emailed, please check the box below and
provide your email address. The e-statements will deliver your account balance information much faster to your
fingertips.
Email Address: _____________________________________________________________________________________________________
click to sign
signature
click to edit
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