Business Office/Water Department

Macomb, Illinois

Automated Payment Application

I authorize the City of Macomb to initate debit entries to my account indicated below at the depository finanical institution named below. I acknowledge that the origination of ACH tranactions to my account must comply with the provisions of U.S. Law. The debit authorization is limited soley to the payment of city of Macomb bills for water, sewer, and trash collections services.

Name as it appears on bill(Required)
Service Address(Required)
Name as it appears on checking/savings account(Required)
Type of Account(Required)

Your automatic bank payments will remain in effect unless we receive written notice from you 5 BUSINESS DAYS PRIOR to the next scheduled due date. A separate authorization form must be completed for each water service address. Notification must be given to the business office to change automatic payments to a new Macomb address

Failure to provide one could result in fees to be paid by the customer
Max. file size: 50 MB.
please initial
MM slash DD slash YYYY

City of Macomb Business Office 309-833-2031 | PO Box 377 Macomb, IL, 61455 |

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