Automatic Payment Plan Application

Never again worry about being late on your payment. You may have your monthly invoice amount automatically paid from your checking account by completing this form.

If you would prefer to print and fill out a form offline, please download our Automatic Payments via Checking Account form.

Account Basics:

Today's Date
District Account Number
Name on Account
First Name
Last Name
Email Address
Phone Number

Service Address:

Street Address
City
State
Zip Code

Banking Details:

Financial Institution
Transit/Routing Number
Confirm Transit/Routing Number
Account Number
Confirm Account Number
List of U.S. Bank Routing Transit Numbers
Bank check image showing routing and account numbers

Authorization:

I (we) hereby authorize King County Water District 90 (DISTRICT) to automatically withdraw from my (our) checking or savings account (identified above), the amount stated on my (our) bi-monthly statement for all water and street light charges at the above service address and the FINANCIAL INSTITUTION named below, to accept such withdrawals initiated by the DISTRICT the withdrawals shall be made from my (our) checking or savings account 15 days after the billing date on my (our) bi-monthly statement.

This authorization is to remain in effect until the DISTRICT has received written notification from me (or either of us) of termination in such time as to afford the DISTRICT and the FINANCIAL INSTITUTION a reasonable opportunity to act on it. I (we) am aware of my right to stop payment of a withdrawal by notifying the FINANCIAL INSTITUTION at any time up to three business days before the withdrawal date. If an erroneous withdrawal occurs and I (we) notify the FINANCIAL INSTITUTION of the error within 60 days of the issuance of my (our) FINANCIAL INSTITUTION's account statement, the FINANCIAL INSTITUTION must investigate and resolve the error within a reasonable amount of time.

I understand and authorize that should any of the debit deposits made through this agreement be dishonored for insufficient funds (NSF), the amount due is payable at the district office, in full, within 72 hours after notification by the DISTRICT, along with a collection fee of $25.00.