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EFT Debit Authorization

  1. Setup*

    Choose New or Change to setup an Auto Pay option, choose Cancel to remove an Auto Pay

  2. (if applicable)

  3. (if different from above)

  4. Financial Information

    The EFT Debit Authorization is to remain in full force until ACWWA has received a cancelation notification of its termination. All fields are required to insure the accuracy of the financial information.

  5. Account Type*

  6. Account Classification*

  7. Authorization*

    This form must be received by the 15th of the current month to start or cancel an Auto Pay. ACWWA will withdraw the funds on the 20th of every month or the closest business day after. A letter of confirmation verifying the EFT will be sent to your address or email provided. By checking this box, you acknowledge and authorize ACWWA to make the above changes to your account.

  8. Leave This Blank:

  9. This field is not part of the form submission.