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Bank Draft Payment Submission Form
Name on Account:
Email Address:
Phone Number:
Service Address:
Billing Address:
CPWA Account #:
Bank Name:
Bank Routing Number (9 Digits):
Bank Account Number:
Type of Account:Checking Savings

I hereby authorize the Clifton Park Water Authority to debit my checking/savings account for payment of my water bill. Further, the CPWA may, if necessary, initiate credit entries and adjustments for water charges. This authority will remain in full force and effect until written notification of termination has been received by the CPWA in a manner as to afford the CPWA and the Depository a reasonable time to act upon it.

There is no additional charge for this service. However, in the event debit entries are rejected by the Depository due to insufficient funds or closed account, the return will be treated as a returned entry and our normal procedures/charges will apply.

This is not for one time payments. Automatic payment will NOT pay any current balances. Automatic withdrawal from your bank account will begin with the next billing after submission of this form.

By clicking on the submit button below you agree to the terms and conditions stated above.

Write the characters in the image above