Authorization for Automatic Payment of Utility Bills – Online Form Account Name * Utility Acct. No. * Service Address * Daytime Phone * Mailing Address (if different) * City * State * Zip * Email Address * Would You Like Paperless Billing? (Bills will be emailed monthly) * Yes No Send me a paper bill monthly Account Type * Checking Savings Bank Name * Routing No. * Bank Acct. No. * Your Authorization: * I authorize Delta Charter Township to deduct my payment from the checking or savings account indicated above. I understand that I control my payment and if at anytime I decide to discontinue this payment service, I will notify Delta Charter Township. Furthermore, I understand that Delta Charter Township may discontinue this service at anytime and that penalties apply if the account has insufficient funds on the due date. I authorize Delta Charter Township to email my monthly utility bill(s) to the email address indicated above. The monthly utility bill is the only statement that will be emailed. I understand that I will no longer receive a printed utility bill. I will notify Delta Charter Township if I wish to receive a printed utility bill again. Failure to receive electronic bill does not entitle customer to discount. Please note: Forms must me received by the 15th of the month to be effective for payment of the following month's bill. Enter the text below.