Auto-Pay Authorization Form

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By submitting this form, I authorize Leavenworth Water Department and the financial institute named here to deduct from my account the amount of my monthly service bill on the delinquent date. This option will be effective when indicated on my bill. This authority will remain in full force and effective until revoked by me, my financial institution, or Leavenworth Water Department. To cancel this option, I must notify the Leavenworth Water Department in writing. I have a right to stop an EASY-PAY deduction by notifying Leavenworth Water Department at least three business days prior to the effective date. Also, I agree that I remain obligated to pay for utility service in the event that a charge to my account is dishonored, for whatever reason, and Leavenworth Water Department remains as it normal collection rights.