Timely Automatic Payment (TAP) Program Enrollment Form for Wastewater Customers

Your Name & Contact Information

First Name Last Name Customer Account Number Phone Number Email Address

Service Address City State Zip Code

Payment Information
Financial Institution Routing No. Account No.
Sample Check for finding your Routing Number and Account Number.

Type of Account
Yes, I authorize The York Water Company to instruct my financial institution to make payments directly from the account listed above. I understand that I may discontinue this payment service at any time by notifying The York Water Company.