1225 Cedar Lane Northbrook, Illinois 60062 847 . 2 72.5 050 Fa x 8 47 . 272. 189 2 www.northbrook.i l.us
By completing and returning the Village of Northbrook Auto Pay Agreement, you’re authorizing
the Village of Northbrook to deduct your water service charges from your bank account
on the due date each quarter.
Once set up, you will continue to get paper bills, showing the amount to be withdrawn.
This Agreement will remain in effect until you notify us to end it, or your water account is
terminated.
IF YOUR BANK ACCOUNT CHANGES, YOU MUST NOTIFY US TO AVOID ANY
REJECTED PAYMENT FEES.
For questions: call us at (847) 664-4171 or email water@northbrook.il.us
Complete the information below
and return to us ALONG WITH A VOIDED CHECK
- By email to water@northbrook.il.us
Attach a photo of the signed form and the voided check.
- By fax to (847) 272-9760
- In one of our green drop boxes: behind Village Hall,
Wood Oaks School or the Police Department on Landwehr
- By mail or in person to Village Hall, 1225 Cedar Lane, Northbrook IL 60062
Customer Name (as on bill) _____________________________________________
Service Address ____________________________________Northbrook, IL 60062
Mailing Address (if different) ____________________________________________
Water Account Number __-________-______-________-________-______
Phone Number __________________ Email ______________________________
Bank Name _________________________________________________________
Bank Address (if not in Illinois) _________________________________________
Routing Number ______________Bank Account Number ____________________
Account type [ ] Checking [ ] Savings
I hereby authorize the Village of Northbrook to debit the above account for the quarterly water service.
SIGNED ____________________________________ DATE ______________________
