Online Automatic Water Bill Payment Authorization Form

Using this form generates an email that is sent directly to our accounting staff. Digital forms are not stored on our servers. They are used to set up ACH through our bank, and deleted for security purposes. CPNMD does not share this information with any other parties.

If you have multiple accounts, please submit a separate form for each account.

AUTOMATIC WATER BILL PAYMENT AUTHORIZATION FORM (required)

YES! I want the convenience of making automatic bank draft (ACH) payments. I hereby authorize Castle Pines North Metropolitan District (“CPNMD”) to initiate debit entries for my monthly water, wastewater, and stormwater utility bill from my account at the bank indicated below. I hereby authorize the bank to accept debit entries CPNMD initiates and to debit same to my account without liability for the correctness of the entries.

Customer Information

Customer Name(s) (required)

Service Address (required)

City (required)

State (required)

Zip Code (required)

Phone Number (required)

Water Billing Account Number (required)

Banking Information

Bank Name (required)

Bank Routing/ Transit Number (required)

Bank Account Number (required)

Voided Check (front of check, no deposit slips) OR a screenshot of your account that verifies routing and checking account number

Upload photo (required)

Electronic Signature

Sign Here by typing your full name (required)

Today's Date (required)

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If you have multiple accounts, please submit a separate form for each account.

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