Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Add/Update Auto-Pay

  1. PLEASE COMPLETE THE FORM BELOW TO
    REQUEST AUTOMATIC PAYMENTS OR CHANGE YOUR PAYMENT INFORMATION

    Changes to customer accounts, including requests for automatic recurring payments may take up to two billing cycles to take effect.

    Please note: Automatic recurring payments will be debited from your bank account on the first day of the month in which your bill is due.

  2. Request Utility Billing Changes
    Form: Add or Update Auto-Pay

  3. Customer Information

  4. account number listed on your water bill

  5. Request:*

  6. Terms and Conditions*


    **Requests to set up or change automatic payments will require a signed printed form. Please print form, fill in bank information and return by fax, mail, or drop off in person.

    For security reasons, please do not share bank account information online or send via email.

  7. Bank Information (print form to complete)


    **To set up or make changes to automatic payments
    Please print form, then complete with bank account information and send to:
    City of Canal Winchester
    Attn: Utility Billing
    36 S. High St.
    Canal Winchester, OH 43110
    Fax: 614-837-0145
    For security reasons, please do not share bank account information online or send via email.

  8. Bank


    ________________________________________________________

    Please note: Automatic recurring payments will be debited from your bank account on the first day of the month in which your bill is due.

  9. Routing (ABA) Number


    ___________________________________

  10. Account Number


    ___________________________________

  11. Account Type

  12. Signature


    ______________________________________________
    (required to set up or make changes to automatic payments)

  13. Leave This Blank: