AutoPay Sign Up Form
Account Name
*
First Name
Last Name
City of Albion Account Number
*
Please Enter your Account Number as Shown on Your Bill
What Date Would You Like Your Payment Taken Out?
*
Please Select
15th
20th
Type of Bank Account
*
Checking
Savings
Routing Number
*
Bank Account Number
*
Submit Authorization*
*Sensitive Information Notice
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