Water Bill Automatic Withdrawal Form

City Hall | 300 E 9 Mile | 248-546-2374 | waterbilling@ferndalemi.gov

Only the property owner or property manager may set up automatic withdrawals. This service is not available to tenants.

It takes two billing cycles for automatic withdrawals to begin. Once your account information has been received and entered, it is verified with your bank when your next quarterly water bill is generated; you will still need to pay this bill manually. Automatic withdrawals will begin with the following bill.

Withdrawals are made on the due date of the bill. If the due date falls on a day when the City offices are closed, the withdrawal will be made on the following business day.

Final water bills are not eligible for automatic withdrawal, and must be paid manually.

Water Account Number (upper-left corner of bill, or top-center of screen on BSA Online)

Water Service Address

Name

Who are you?

Tenant – Not eligible for automatic withdrawals; do not submit this form

Property owner

Property management company hired by the owner

I want to:

BEGIN automatic withdrawals for my account, or UPDATE my bank information

END automatic withdrawals for my account, effective immediately

Mailing Address to send billing statement (if different from service address)

Phone Number

Bank Routing Number (9 digits)

Checking Account Number

Submit Voided Check (A voided check is required for verification of routing & account numbers. Please upload a scan of your voided check using the box below.)

Click Here to Upload

Penalty Terms

I hereby authorize the City of Ferndale to deduct my Water/Sewer payment from the checking account listed above and agree that a $35.00 NSF fee shall be charged in the event funds are insufficient to pay the full amount at the time of withdrawal, in addition to the 10% late penalty.

By signing I agree to the penalty terms above and I am authorizing the City of Ferndale to deduct funds from my account to pay my Water/Sewer bill.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.