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LAN-DEL Water District

DIRECT-PAY Authorization Form

All fields required.

Your Information

Financial Institution

Signature

By signing above, I authorize LAN-DEL Water District and financial institution named by me to deduct from my account the amount of my monthly service amount due. This option will be effective the 15th day of each month, or next business day. This authority remains in effect until revoked by me, my financial institution, or LAN-DEL Water District. To cancel this option, I must notify LAN-DEL Water District in writing 30 days in advance of the cancellation date. I agree that I am obligated to pay my bill if my deduction is dishonored. If a deduction is dishonored, the deduction amount plus a returned item fee of $50 is due the day after LAN-DEL Water District received a bank notification. Payment can be made with cash, debit, or credit card. LAN-DEL Water District retains its normal collection rights.

A voided check from your financial institution is required to complete enrollment. Please email a photo to office@lan-del.com.