Automatic Payment Plan

Dear Water Customer, Charlevoix Township now has an automatic payment plan for your water bill. Each month your bill will be automatically deducted from your checking or savings account on the date it is normally due, the 15th of each month. The plan is quick, simple, and helps avoid penalties and it’s free. To participate in the automatic payment plan, simply fill out the form below and return it to us with a voided check with your bank ABA routing number on it.

Name(Required)

First Last

Address

Street Address City State ZIP Code

Utility Account #(Required)

Daytime Phone #(Required)

Your Financial Institution Information:

Name of Bank or Credit Union:(Required)

Account #(Required)

Type of Account(Required)

ABA Routing Number:(Required)

(This information is on the check or may be obtained from your financial institution.)

Authorization:

I authorize Charlevoix Township to deduct my utility bill payment from the checking or savings account shown above. I am the owner of the account listed and I also authorize any necessary adjustment that may be required. I may discontinue payments at anytime by notifying the Charlevoix Township Clerk. Please allow at least 30 days for withdrawals to begin.

Signature(Required)

Date(Required)

Please allow at least 30 days for withdrawals to begin.