ACH FormFill out the information below and include a voided copy of your check. Your information is secure and will not be shared.Bank Name (required)Cottonwood Water Account Number (required)Bank Account Number (required)Street Address (required)Bank Routing Number (required)Phone Number (required)Name on Bank Account (required)Email Address (required)I authorize the Cottonwood Water and Sanitation District and the financial institution above to transfer (debit) money from my account (checking) and remit payment for my water and sewer bill on the 25th or the next business day, of every month. This authorization will remain in full force and effect until Cottonwood Water has received a 30 DAY WRITTEN notice from me of its termination. If the draw is returned by the bank for any reason, Cottonwood Water will charge my account a $30 (thirty) fee for bank processing. Please allow 30 days for processing. (required)I have read and agree to the above terms and conditions.Print Name and Date (required)Upload your voided check below (required)There was a problem saving your submission. Please try again later.Please wait while your submission is being saved...Submitting...SubmitThank you, your submission has been received.Download the form here to send into CWSD
