Antioch, CA · Contra Costa County
Automatic Payments Authorization Form
Antioch water customers use this form to start, update, or cancel automatic payments from a checking account for their water bills.
What this form is
Use this form to authorize automatic deductions from a checking account for City of Antioch water bills, or to update or cancel participation. It asks for the account holder’s name, service address, phone number, water account number, signature, and date. Include an original or photocopy of a voided check; the form says changes or cancellations must be received in writing at least 72 hours before the draft date.
Who needs it
Water customers who want to start, update, or cancel automatic payments must complete the form and provide the requested checking account details.
How to submit it
Return the form and voided check by fax at 925-779-7054, email to [email protected], or in person.
About notarization
This form is signed and dated without a notary; attach an original or photocopy of a voided check from the checking account.
How to submit this form
- 1
Download The Form
Download the Automatic Payments Authorization Form.
- 2
Complete The Form
Select the applicable option and fill in the account name, service address, daytime phone, water account number or numbers, signature, and date.
- 3
Attach A Voided Check
Include an original or photocopy of a voided check. The form says temporary checks and deposit slips cannot be accepted.
- 4
Return The Form
Return it by fax at 925-779-7054, email to [email protected], or in person.
Frequently asked questions
- Do I need a notary for the Automatic Payments Authorization Form?
- No. Sign and date the form without a notary, and attach an original or photocopy of a voided check from the checking account.
- How do I submit the Automatic Payments Authorization Form?
- Return the completed form and voided check by fax at 925-779-7054, email to [email protected], or in person.
- What information does the form ask for?
- It asks for the account name, service address, daytime phone, water account number or numbers, signature, and date.
- Can I update or cancel automatic payments?
- Yes. Submit a new full form and select Update or Cancel. The form says changes or cancellations must be received in writing at least 72 hours before the draft date.
Need something notarized?
This Automatic Payments Authorization Form doesn’t need a notary — but if you have another Antioch form that does, a commissioned online notary can help.