City of Bloomington Utilities
Authorization Agreement for Preauthorized Payments (Aqua Pay)
Sign up for automatic payments
from either your checking or savings account. With AquaPay, your balance due will be automatically drawn each month on the due date of your bill. You will still receive a bill in the mail (or by e-mail for
customers) for your records showing the charges each month, but once enrolled you will never need to write a check to us again!
Customer Service Office Contact Information
8:00 am to 5:00 pm M-F
600 E Miller Dr
Bloomington IN 47401
Field is Required
(Please provide an email address to receive a confirmation email and status updates)
City of Bloomington Utilities Account Number
The service address is:
If completing this form as an individual please complete the following.
Date of Birth
If completing this form as a company please complete the following.
Business Customer's Federal TIN
Date of Incorporation
Name of your Financial Institution
Type of Account
Name of your Authorizing Authority
I hereby authorize City of Bloomington Utilities, hereinafter called the COMPANY, to initiate ACH debits to the account identified in this form and authorize the institution to charge such debits to my account.
Such debits shall be equal to monthly utility bill and payable monthly on the due date. Adjusting entries to correct errors are so authorized. It is agreed that these debits and adjustments will be made electronically and under the rules of the National Automated Clearing House Association (NACHA). This authorization is to remain in full force and effect until written notification is given to the COMPANY of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
Final bills will NOT automatically be withdrawn from accounts.
I affirm that the information contained herein, including attachment(s), is complete and accurate.
Click if you Agree