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Payment Type: Electronic Check
(from your checking or savings account)

Please provide your bank's name.
Please provide your ABA / Routing Number. It's the first number at bottom of check.
Please provide your primary phone number.
Please provide your email address.
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I (we) hereby authorize Angelina Water Supply Corporation ("Angelina") to automatically withdraw from my Checking Account or Credit Card the amount the total amount due on my billing statement and to make deposits if necessary for error correction. I authorize the Financial Institution named above to accept such transactions initiated by Angelina. Deductions will be made on the first business day after the designated due date. I am aware of my right to stop a withdrawal by notifying Angelina. at any time up to three (3) business days before the withdrawal date. If an erroneous withdrawal occurs and I notify the Financial Institution of the error within 60 days of the issuance of my account statement, the institution must investigate and resolve the error within 45 days of notification. If the error is not resolved within the first 10 business days following receipt of my notification, my account shall be recredited for the amount in question until the investigation is completed. (Condensed for Regulation E, Electronic Fund Transfer Act for the consumer's protection. For more information, contact your Financial Institution.)

By sending in this request to activate your Monthly Recurring Billing you are agreeing to the above terms.

You must agree to the terms.
Please provide your full name for approval.