City of Rochester Hills Water/Sewer Utility Bill Automatic Payment Enrollment Form
Enrollment for automatic payment via checking or savings account.

The City of Rochester Hills offers at no charge automatic bill payment of your water/sewer bill via your checking or savings account. You will still receive your bill in your normal way informing you of the amount due and the date the payment will be deducted from your bank account.

Please note: You are to continue to pay your bill as usual until your water/sewer bill states "ENROLLED IN AUTOMATIC BILL PAYMENT - DO NOT PAY." At that time you may stop sending payments--normally within one billing cycle.

If you have any questions about this form, please contact the Rochester Hills Treasury Department via email at treasury@rochesterhills.org or by phone at 248.841.2580.

Water/Sewer Account #
Your answer
Account Status
First Name *
Your answer
Last Name *
Your answer
Water/Sewer Account Address *
Your answer
Mailing Address (if different)
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Bank Account Information
Financial Institution Name *
Your answer
Routing Number (must be 9 digits) *
IMPORTANT: Please be sure to provide either a checking account or savings account number below.
Your answer
Checking Account Number
Please include leading zeroes (Example: 00012345)
Your answer
Savings Account Number
Please include leading zeroes (Example: 00012345)
Your answer
Agreement and Authorization
Authorization *
I hereby authorize the City of Rochester Hills to make recurring deductions on the bill due date for my Water/Sewer Bill for the total amount due from the checking or savings account listed above. I acknowledge that a $30.00 returned item fee shall be charged if my payment to the city is rejected by my bank due to insufficient funds or if the account is closed, in addition to the late penalty fee.
Required
Electronic Signature *
I hereby certify that by checking "I agree" in the authorization above and typing my full name below, I am entering into a legally binding contract between the City of Rochester Hills and myself or the entity I am authorized to represent.
Your answer
Date *
MM
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DD
/
YYYY
Additional Comments
Your answer
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