eCheck Payment Submission Form
Account Name
*
First Name
Last Name
City of Albion Account Number
*
Please Enter your Account Number as Shown on Your Bill
Payment Amount
*
Enter the Amount you Authorize to be Paid
Routing Number
*
Bank Account Number
*
Type of Bank Account
*
Checking
Savings
Submit Authorization*
*Sensitive Information Notice
The information entered in this form are encrypted with the latest standards. We value the protection of your sensitive data and are constantly working to keep security updated.
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