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Automatic Payment for Waterbill

  1. Village of Lake Zurich - Application for Automatic Payment of Water Bill
    I hereby authorize the Village of Lake Zurich and the financial institution listed below to pay my water bill on the scheduled due date of the bill. Each payment will be the same as if it were personally signed and authorized by me. This authority is to remain in effect until the Village of Lake Zurich has received written notification from me of the termination, a minimum of 10 business days prior to the scheduled due date. The Village of Lake Zurich reserves the right to terminate this payment plan or my participation with written notification.
  2. Application Processing Period
    Processing of this application will occur in the next 30 days. I am responsible for paying my water bill to the Village of Lake Zurich until my bill indicates that my direct debit payment program is established. My bill will note when the direct debit begins. I will continue to be mailed a regular bill for my records.
  3. Type of Account*
  4. You can find this on your water bill
  5. Enter your full name above to accept the terms of this application.
  6. Next Steps
    We will confirm your application via email within the next 4 business days. It will take two (2) billing cycles before the automatic payment will become effective. Please call us at 847-438-5141 if you have any questions.
  7. We recommend that you DO NOT elect to receive and email copy of this form.
  8. Leave This Blank:

  9. This field is not part of the form submission.