Traverse City Utilities
Water and Sewer Department
Traverse City Light and Power Department
Auto Debit Enrollment Form
Follow the four easy steps detailed below to complete the enrollment process.
1. Complete the contact information requested below. Please print.
Name (as shown on your utility bill):
Service Address:
City: State: Zip:
Phone Number:
2. Provide your signature for authorization.
I authorize the City of Traverse City/Traverse City Light and Power to deduct my payment(s) from
the checking or savings account listed below. I understand that I control my payments and if at
any time I decide to discontinue service I will notify the City of Traverse City/Traverse City
Light and Power. I also understand that all information provided will remain confidential.
Printed Name:
Signature: Date:
3. Provide the required financial information below.
To ensure the correct account number is used for this electronic payment and to obtain the
ABA/routing number, YOU MUST PROVIDE A VOIDED CHECK WITH YOUR AUTO
DEBIT ENROLLMENT FORM. Debit slips are not accepted.
Name of financial institution:
ABA/routing number:
Checking Account Number:
-or-
Savings Account Number:
4. List your utility account number(s) that you would like enrolled in the Auto Debit Program.
Account Number:
5. Go Green! Sign up for paperless billing.
Email:
PLEASE PRINT, SIGN AND MAIL/DROP OFF THIS FORM, ALONG WITH A VOIDED
CHECK, TO THE FOLLOWING ADDRESS: CITY OF TRAVERSE CITY, 400
BOARDMAN AVENUE, TRAVERSE CITY, MI 49684.
THIS FORM CANNOT BE PROCESSED WITHOUT YOUR SIGNATURE.
For questions, please call Customer Service at 231-922-4431
click to sign
signature
click to edit
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