Water and Sewer Automatic Bill Payment Application

Automatic Bill Payment Authorization Form

This is an application form from The Borough of Hollidaysburg, PA for setting up automatic payments for water and/or sewer bills.

Purpose

Residents can authorize the Borough to automatically deduct their water/sewer payments from a bank account.

Required Information

Applicants must complete:

• Applicant Information:

  • Name and phone number
  • Street address, city, and zip code

• Service Address:

  • Street address, city, and zip code (if different from applicant)

• Financial Institution Information:

  • Name of bank, savings & loan, or credit union
  • Account number
  • Account type (checking or savings)

• Signature and Date

Important Notes

• Residents control their payments and can discontinue the service by notifying the Borough in writing
• A voided check must be attached when returning the form
• The Borough’s contact information is provided for questions or to cancel service

Contact Information

• Address: 401 Blair Street, Hollidaysburg, PA 16648
• Phone: (814) 695-7543
• Fax: (814) 696-0636
• Website: www.hollidaysburgpa.org