Electronic Payment Form

Experience the convenience and cost savings of having your bill automatically deducted from your checking account. No more checks to write, stamps to buy, late fees or interruption of service. Take advantage of this free payment method. The amount due will be automatically deducted from your checking account on the due date. You will continue to receive a copy of your bill for your records. Please continue paying your bill until “Do Not Pay – You are signed up for Auto Pay” appears on your bill, as the set up process can take up to 8 weeks.
Customer Information
Banking Information
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png.
Authorization
 
  • I/We hereby authorize Frederick Water to initiate debit entries or such adjusting entries, either debit or credit which are necessary for corrections, to my Checking account indicated above and the financial institution named above to credit (or debit) the same to such account. I/We also understand that Frederick Water and the financial institute reserve the right to terminate this payment plan and/or my participation in it. 
     
  • I/We agree to maintain this account in good standing and understand that failure to maintain this account without notification of changes in advance to Frederick Water may result in termination of services. Any payment not honored by the bank for any reason will result in fees, penalties, other charges and the automatic payment plan stopped.
     
  • I/We understand that this authorization will remain in full force and effect until Frederick Water has received written notification to terminate this authorization. Written notification must be received at least ten (10) business days before the automatic payment is scheduled to be deducted from your account. If less time is allowed, Frederick Water will try, but not guarantee, to stop the automatic payment.
     
  •  I/We have read and understand the above authorization agreement for the Automatic Payment Plan (EFT Debits).