Auto-Pay Enrollment Authorization Form 2026

1. Click ‘Get Form’ to open the Auto-Pay Enrollment Authorization Form in our editor.
2. Begin by filling out the Customer Information section. Enter your Name, Service Street Address, Account Number, Telephone Number, City, State, and Zip code accurately.
3. Choose between Bank Draft or Credit Card for payment. If you select Bank Draft, complete the Financial Institution Name, Name of Accountholder, Routing #, and Account # fields.
4. If opting for Credit Card, indicate the Type of Card (MasterCard, Visa, Discover), then fill in the Name on Card, Credit Card #, Expiration Date, Billing Street Address, City, State, and Zip code.
5. Review the authorization statement carefully. Ensure you understand your rights regarding ACH transactions and any fees that may apply.
6. Sign and date the form in the designated areas to confirm your authorization.
7. Finally, return the completed form via fax or mail as instructed at the bottom of the document.

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