Required fields are marked with asterisks (*)

Account Authorization Form - FOR OWNER'S ONLY

This form is intended to authorize others to gain access to the newly created account and can only be completed by the registered owner of the property.

Current Account Number

Service Address

Current Name on Account

Registered Owner Name #1

Registered Owner Name #2

Effective Transition Date (Any Date from today to April 1, 2025)

How do you want to receive your bills?

Mailed

Emailed

Do you want anyone else to have access to the account? List name(s)

What access should they have to the account?

Minimum Access

Full Access

(Minimum access will authorize individuals to access the account balance and make payments, including preauthorized payments. Full access will authorize individuals to access the account balance and make payments, including preauthorized payments, and make changes to the entire account.

Note: The account for this service address will now default to the property owner, therefore any previous e-billing and preauthorized information will be removed from our system.

If you currently have preauthorized payments for another service address for your water/wastewater billing in the municipality, do you want this banking information transferred to this water service as well?

Yes

Signature

Clear