Pre-Authorized Credit Card Payments

Pre-Authorized Credit Card Payments - Water/Sewer
I hereby authorize the City of Miramichi to charge the amount equal to the quarterly water and sewage invoice (pay on due date), for the following address, to the credit card number indicated below.

Please note that for security purposes an employee of the City of Miramichi will contact you to verify your credit card information.
12 Digit Water/Sewer Account Number:
Name:

First NameLast Name
Property owner (if different from above)

First NameLast Name
Service Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (If Different From Service Address):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email:
example@example.com
Credit Card Number:
Expiry:
Property Owner Signature:
Should be Empty:

Pre-Authorized Credit Card Payments - Water/Sewer