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Automatic Withdrawal Authorization

To sign up for automatic withdrawal, please fill out the online form below or download and complete the printable form here: Automatic Withdrawal Authorization Form
Completed printable forms may be mailed or brought to City Hall along with a voided check from your financial institution. If you prefer to email your form and voided check, please send to Accounting Clerk Emily Light at elight@adeliowa.org
Automatic Withdrawal Authorization Forms must be submitted by the 15th of the month to be applied as the payment method for that month’s bill. Any forms submitted after the 15th will be applied to the following month’s bill.
If you have a recurring online payment set up through our City of Adel, IA – Municipal Online Services (municipalonlinepayments.com) that recurring payment needs to be cancelled before an automatic withdrawal from your bank account may be activated.

Automatic Withdrawal Authorization

"*" indicates required fields

I (we) hereby authorize the CITY OF ADEL to initiate debit entries to my (our) checking account indicated below and the depository named below, hereinafter called DEPOSITORY, to debit the same to such account.
Bank Address*
(Transit ABA Number is the first 9 numbers from left on bottom of your check)
This authority is to remain in full force and effect until the City of Adel and Depository have received written notification from me (either of us) of its termination in such time and in such manner as to afford the City of Adel and Depository a reasonable opportunity to act on it.
Name*
Second Applicant Name
(if applicable)
Service Address*
The person signing this agreement is the responsible party.
The person signing this agreement is the responsible party.
Max. file size: 2 MB.
You will receive your water bill on the first of the month as usual. The amount due will be deducted from the above assigned account of the 20th of each month.