CITY OF WYOMING
WATER BILL
AUTO PAY ENROLLMENT FORM
In response to many requests from customers like you, we are happy to offer a payment option that will
automatically pay your water and sewer bill from your checking or savings account. Simply complete the
enrollment form, print and return with a voided check to:
City of Wyoming
Treasurer’s Office
PO Box 908
Wyoming, MI 49509-0908
It’s that easy !
Allow 30 days for enrollment to or termination from the Auto Pay program. The City reserves the right to
incorporate Auto Pay program guidelines into the Water System Rules and Regulations.
I authorize the City of Wyoming and my financial institution to automatically deduct my water/sewer payment from the checking or savings
account listed below. I understand that either party can cancel, in writing, at any time. I can notify the City in writing to terminate this
authorization at any time.
Utility Account Number: _____________________
Name on account: ___________________________
Service address: _____________________________
Name of Financial Institution:___________________
Bank Account Number:________________________
Routing and Transit Number:___________________
Account Type (select one):
Savings Checking
Important Note:
To ensure proper account information, you MUST attach a CHECK marked VOID. Enrollment cannot be completed without your
signature below:
Accountholder Signature: Date:
________________________ _____________
Daytime Phone Number: ______________________
Please PRINT and return this portion with voided check to:
City of Wyoming Treasurer
PO Box 908
Wyoming MI 49509-0908
click to sign
signature
click to edit
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