EZ Pay Application

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Water Account Number *

Name *

First

Last

Service Address *

Address Line 1

City

State

Phone Number *

Bank Name *

Bank Routing Number (please confirm by entering twice) *

Password

Confirm Password

Bank Account Number (please confirm by entering twice) *

Password

Confirm Password

EZPay Payment Plan Agreement

A notice of your enrollment into the EZPay Payment Plan will appear on your bill. Please continue to make payments until the amount due portion of the bill has the words EZPAY. I hereby authorize Community Water Company of Green Valley and the financial institution designated on this application to charge the account I have specified for payment of my monthly water bill. I have the right to stop payment of a charge by notifying Community Water Company within five days of the billing date. I understand that a fee will be charged to my account for each request returned for any reason. If two requests are returned, I will be excluded from the plan. In addition, I understand that both the financial institution and Community Water Company reserve the right to terminate this payment plan and/or my participation therein. Should I choose to withdraw from the plan, I will immediately notify the Company. *

I agree