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Electronic Funds Transfer Request

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Electronic Funds Transfer Request

Request Type*
- New
- Change
- Stop
Effective Date*
MM slash DD slash YYYY
REQUIRED: Please attach image of voided Check Below
Customer Name*
Service Address*
Email*
Phone*
Account Number*
Bank Account Type*
- Checking
- Savings (Attach letter from bank verifying routing and account number)
Bank Name*
This is my (our ) authorization to my (our ) bank, named above, to deduct from my (our ) checking/savings account and pay Hudson Water Works, Inc the amount of my (our) monthly water bill. This authorization shall continue until notice of cancellation Is received by Hudson Water Works, Inc. In such time as to afford a reasonable opportunity to act on It.
Signature*

Type your full name to digitally sign
Todays Date*
MM slash DD slash YYYY
Photo ID*
Accepted file types: jpg, gif, png, pdf, jpeg, doc, Max. file size: 512 MB.
Required: Attach a photo or scan of your valid State or Government issued ID for your account security
Voided Check*
Accepted file types: jpg, gif, png, pdf, jpeg, doc, Max. file size: 512 MB.
Required: Attach a photo or scan of your voided check
Bank letter
Accepted file types: jpg, gif, png, pdf, jpeg, doc, Max. file size: 512 MB.
Only required for Savings Accounts. Attach a photo or can of the letter from your bank clearly showing account and routing numbers
* Please continue to pay your bill by check, cash, or money order until your statement shows that your account is In an EFT status.
*Once you have submitted your voided check you cannot pay online or over the phone with a credit card.
It will take approximately 4 to 6 weeks from the time we receive your voided check until your payment will be automatically deducted.
Privacy*
- I consent to my submitted data being collected and stored