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AUTOMATIC BILL PAYMENT ENROLLMENT (ACH) FORM CITY OF MIDDLETON - WATER UTILITY 7426 HUBBARD AVE, MIDDLETON, WI 53562 (608) 821-8370 ● FAX (608) 827-1080 [EMAIL REDACTED] Please include a voided check if you are not returning this form with a check payment. Name Utility Account # Service Address Middleton, WI, 53562 Billing Address (if different) City, State, Zip Phone # Email Name of Bank Bank Account # Bank Routing # Authorized Signature Date How does it work? Complete this form and return with a voided check to City Hall. We will continue to mail your quarterly statement with an autopay “do not pay” message on it. When will this take effect? With your next billing statement. How will my bill be paid? The amount due will automatically be deducted from your account on the due date that is shown on your quarterly bill. How can I be sure my bill has been paid? Payment will appear on your checking account statement as a transaction to City of Middleton. It will also appear paid on your next bill from us. What if I want to stop the automatic payment plan? You can quit the program anytime. Please contact us in writing.