Take it easy with the City of Selah’s Automatic Payment Plan (APP). This convenient plan will give you peace of mind and save you the cost of buying stamps. When you enroll in the plan you will receive your monthly utility bill as usual. Instead of writing a check and mailing your payment, or driving to City Hall to make your payment, you simply enter the amount of the payment in your checking account register. With the APP, your bank account is automatically debited on the day that your payment is due so you can be assured that your utility bill will be paid on time every month. Electronic transactions are protected by federal regulation. You may cancel the APP by contacting the City of Selah by at least the 15^th day of the month in which you desire to discontinue participation.

To sign up for the Automatic Payment Plan (APP) please fill out the form below and return it to the City of Selah along with a voided check. (If you have multiple utility accounts you wish to enroll in the APP, attach a listing of those accounts.)

AUTOMATIC PAYMENT PLAN AUTHORIZATION AGREEMENT

I (we) hereby authorize the City of Selah to automatically withdraw from my (our) bank account identified below the amount due on my (our) monthly billing statement(s) for the utility account(s) listed below. I (we) authorize the Financial Institution listed below to accept such withdrawals initiated by the City of Selah. The withdrawals shall be made from my (our) bank account on the 20^th day of each month, or the next working day if the 20^th falls on a weekend or holiday.

Utility Account No(s): _____________________________

                                     _____________________________

Customer Name(s): _________________________________________________

Service Address(es): ________________________________________________

Financial Institution: _________________________________________________

Branch: __________________ Checking Account No: _________________________

Transit/Routing No. ______________________

(First 9 numbers of the encoded line at bottom of check)

This authorization is to remain in effect until the City of Selah and the Financial Institution have received notification from me of termination. I (we) understand that such notification must be received by the City of Selah by the 15^th day of the month in which I (we) desire to terminate participation. I am (we are) aware of my (our) right to stop payment of a withdrawal by notifying the Financial Institution at any time up to 3 business days before the withdrawal date. If a withdrawal is refused by my (our) Financial Institution due to insufficient funds, my (our) utility account will be assessed a $ 20.00 NSF fee.

SIGNATURE(s): __________________________   ___________________________

Answers to Frequently Asked Questions Concerning the Automatic Payment Plan:

May I have a withdrawal made from my savings account?

At this time the City of Selah only allows withdrawals from financial accounts which can issue checks.

May I pick a date other than the 20^th for the payments to be withdrawn from my checking account?

At this time payments may only be deducted on the due date of the 20^th. If the 20^th falls on a weekend or holiday the deduction will occur on the next working day.

You must contact City utility billing staff by the 15^th of the month in which you desire to terminate participation.