Fillable ENROLLMENT FORM YES! I would like to enjoy (City of South Burlington)

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ENROLLMENT FORM YES! I would like to enjoy (City of South Burlington)

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ENROLLMENT FORM
YES! I would like to enjoy the safety and convenience of enrolling in a free, Automated Tax Payment
Program.
To enroll simply:
1. Write “VOID” across a check for the checking account from which you want your tax payment to
be withdrawn and complete the account information section at the bottom of this page. Or, if
you would like your payments withdrawn from your savings or money market account, please
complete the account information section at the bottom of this page.
2. Sign this form and mail it with your voided check to:
City of South Burlington
Tax Department
575 Dorset Street
South Burlington, VT 05403
I authorize the City of South Burlington to instruct my financial institution to deduct property tax
payments directly from my account. If, at any time, I wish to discontinue the service, I will simply notify
the South Burlington Tax Collector in writing within 30 days of my next scheduled payment.
Your Signature
Date
Your Name (please print)
Daytime Telephone Number
Address of property to be paid
Property Tax Account Number
Your bank’s name
Account Number
ABA Routing Number
Checking
Savings
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ENROLLMENT FORM YES I would like to enjoy (City of South Burlington)

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Completed 16 July 2020

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