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I am and I agree to be legally bound by this agreement and WP E-Signature Terms of Use.

Automatic Bill Payment Application

I hereby authorize the Municipal Authority of the City of New Kensington, to initiate automated clearinghouse entries to my checking/savings account indicated below and the Financial Institution named below, to credit and/or debit the same to such account.

Applicant Information

Date

Water Authority Account Number(s)

Name

Email

Address

Applicant Information

Date

Water Authority Account Number(s)

Name

Email

Address

Bank Information

Name

Branch Office Name

Address

Bank Information

Name

Branch Office Name

Address

Check Information

Routing Number

Account Number

Check Information

Routing Number

Account Number

IMPORTANT NOTICE: The application is to remain in full force and effect until the Municipal Authority has received written notification from me of its termination in such time and manner as to afford the Municipal Authority and Financial Institution a reasonable opportunity to act on it. This Authority will automatically debit your checking or savings account on the due date shown on the bill. If you are enrolled in the Automatic Bill Payment Program, you cannot change the payment date or the amount to be paid.

I hereby understand the terms and conditions of the Automatic Bill Payment Program.

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Automatic Bill Payment Application

Applicant Information

Applicant Information

Bank Information

Bank Information

Check Information

Check Information

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