Valparaiso City Utilities

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Direct Debit Authorization Form
I (we) authorize Valparaiso City Utilities and the financial institution listed below to transfer (debit) money from my (our) checking or share drafts account and remit payment for my (our) Water, Sewer, Storm Water and/or Trash bill.
Financial Institution Name
Bank Routing Number
Confirm Bank Routing Number
Bank Account Number
Confirm Bank Account Number
I (we) have read the terms of this application and agree to the terms. This authorization will remain in full force and effective until the Valparaiso City Utilities has received written notification from me (or either of us) of its termination in such time and in such manner as to afford the Valparaiso City Utilities and my financial institution a reasonable opportunity to act on it.
Authorized Person Name
Signature for Authorization
Date (mm-dd-yyyy)
Service Address
Valparaiso City Utilities Account Number
Daytime Phone Number
Email Address
Terms of Agreement

Payment Notice, Payment Date and Billing Questions
You will continue to receive a monthly statement. You will have ample time to plan for your automatic payment or contact us if there is a question about your bill. On your due date, (the 1st or the 20th) the payment will be deducted from your account. If your due date falls on a weekend or holiday, your account will be charged on the next business day.
Availability of Funds
You are responsible for having enough money in the indicated account on the payment date. If the transaction cannot be processed for any reason, a past due notice will then be mailed to you and the payment must be made at our office. You will be responsible for all fees charged, should your payment be returned for any non-payment reason. (These fees may include late charges, non-payment fees, and collection fees.) Also, your automatic bank payment service may be cancelled if two payments are returned in a 12-month period for non-payment.
Record of Payment
The amount and date of your automatic payment will be shown on your regular bank statement. This is your proof of payment. If there is a question about a payment or if the amount differs from your bill for any reason, you must notify us and your financial institution within 60 days of the date on which the error is first reflected.
Account/Address Change
Please notify us of any account or address changes to ensure timely payments. You are responsible for submitting a new application when an account or address change occurs.
Termination
This authorization will remain in effect until we receive a written notice from you 10 days prior to cancellation date or until your service has been terminated and the final bill is paid in full. You may send us a letter requesting the cancellation of Automatic Bank Payment Service or fill out our online cancellation form.
Stop Payments
You should always advise us first of any request to stop payment. You may stop payment by notifying your financial institution at least three business days prior to payment due date. However, as when you stop payment on a check, you are responsible for any charges this may involve.
If you have any other questions, please call our office at (219) 462-6174 ext. 7 for customer service.

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