Glendale, AZ · Maricopa County
Automatic Payment Service Authorization Agreement
Glendale utility customers use this agreement to authorize automatic payment of monthly utility bills from a designated bank account.
What this form is
This agreement lets a City of Glendale utility customer authorize automatic withdrawals for monthly utility bills and optionally add a monthly donation to From the Heart. It asks for utility account, payer, contact, service, and bank details, plus a signature and date; the form says to include a voided check. The city says activation will be confirmed on a billing statement within two billing cycles.
Who needs it
A Glendale utility customer who wants monthly bills paid automatically from a bank account should complete and submit this agreement.
How to submit it
Return the completed application with a voided check by fax, mail, or in person. The form lists fax number 623-930-2186 but gives no mailing address.
About notarization
This authorization is signed and dated without a notary; include a voided check, which the form does not say must be notarized.
How to submit this form
- 1
Download The Agreement
Download the Automatic Payment Service Authorization Agreement.
- 2
Complete The Form
Enter the requested utility, payer, contact, and bank account information, then sign and date the authorization.
- 3
Gather The Attachment
Include a voided check as directed by the form.
- 4
Return The Application
Return the completed application with the voided check by fax, mail, or in person.
Frequently asked questions
- Do I need a notary for the Automatic Payment Service Authorization Agreement?
- No. The form calls for a signature and date, not notarization. Include a voided check; the form does not say it needs notarization.
- How do I submit the Automatic Payment Service Authorization Agreement?
- Return the completed form with a voided check by fax, mail, or in person. The form lists fax number 623-930-2186 but does not provide a mailing address.
- What information does the agreement ask for?
- It asks for utility account and contact details, service and mailing addresses, financial institution information, bank routing and account numbers, and a signature and date.
- When will automatic payments become active?
- The form says a message will appear on your billing statement within two billing cycles to advise that the automated payment service is active.
Need something notarized?
This Automatic Payment Service Authorization Agreement doesn’t need a notary — but if you have another Glendale form that does, a commissioned online notary can help.