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Automatic Payment Plan Request

  1. Automatic Payment Plan Request*
  2. Agreement

    By submitting this form, I authorize the Village of Germantown to instruct my financial institution to deduct my Utility Bill payment due from my account. Approximate withdrawal dates are: April 20th, July 20th, October 20th, and January 20th. If at any time I decide to change my financial institution and/or account number, move from this location, or wish to discontinue this payment service, I will notify the Village of Germantown, in writing, 30 days prior to cancellation. 

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  4. This field is not part of the form submission.