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Direct Utility Pay Agreement

This form is used to enroll in automatic payments for your Clearfield City utility bill.

Questions can be directed to customer service via csc@clearfieldcity.org or 801-525-2701.

Name *

First

Last

Phone Number *

Address *

Address Line 1

City

State

Utility Account Number

This can be found on your utility bill or by calling customer service. If you're unsure, leave blank and we'll look it up.

Check One *

New agreement
Cancel existing agreement

Name of Financial Institution *

Account Number *

Routing Number *

Account Type *

Checking
Savings

I hereby authorize Clearfield City and the financial institution designated in this application to pay my monthly utility bill by withdrawing money directly from my account. I understand that both the financial institution and Clearfield City reserve the right to terminate this payment plan and/or my participation therein. I also understand that I may elect to discontinue my enrollment in this plan at any time by providing written notice to Clearfield City. I understand the payment will be taken from my account on or around the 20th of each month. I also understand that a $20 fee will be assessed for any Auto Pay transaction returned by my financial institution.

Name *

First

Last

Date *

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