NJ.12.2014 THANKS! to our many customers for choosing to go green with EFT and paperless billing! 70,000+ customers Number of customers who pay their bill automatically through our Electronic Fund Transfer program. No paper required! Payment Made Easy SAVE $5.88 in stamps! Printed on paper containing recycled content. Each ton of recycled paper saves 7,000 gallons of water. 24,000 customers Number of New Jersey customers who receive their bill electronically. No paper required! (Keep in mind, we’ve only been offering this program to our customers for about a year.) Cost to use these services FREE Sign up for both of these programs on My H2O Online at www.amwater.com/myh2o. AWxxxi newjerseyamwater.com We offer several convenient options, including automatic payment and paperless billing! Payment Options SAVE YOUR STAMPS! Sign up for EFT! Automatic Payment Program Authorization We offer six convenient payment options. Choose the one that fits your needs the best! (Please print name as shown on bill) 1 Pay Automatically. Name ___________________________________________________ Billing Address ____________________________________________ City______________________State_______Zip ________________ Save time and money. Sign up for SAVE our Electronic Fund Transfer (EFT), $5.88 and your bill will be paid on time, a year in every time, directly from your stamps. checking or savings account on the date it is due. No stamps required. You will still receive a copy of your bill before the due date, so you will have time to ask any questions before payment. Best of all, it’s totally free! To enroll in the program, log on to My H2O Online at www.amwater.com/myh2o or contact our customer service center. For service to (if different than above) ________________________ City______________________State_______Zip ________________ Phone Number (______) ____________________________________ New Jersey American Water Account Number__________________ _________________________________________________________ To participate in New Jersey American Water’s Electronic Fund Transfer Program, I ________________ authorize New Jersey American Water Company to instruct my financial institution named below to make my water bill payments from the following account as they are due: 2 Pay by mail Using the envelope provided with your bill. No cash, please. 3 Pay your bill online* Visit www.water.paymybill.com. Be sure to have your account number handy. 4 Pay by phone* Checking Account Checking Account Number: _____________________________ Routing Number: ______________________________________ See sample below if you’re not sure where these are.) Savings Account (*No passbook accounts please.) Savings Account Number:_______________________________ I understand that I am in full control of the automatic payment service. If I decide to discontinue it, I will notify New Jersey American Water. Please allow 30 days to process your request. I understand this information will be used solely for the purposes of the automatic payment service. 24-hours a day, every day at 1-866-271-5522. Be sure to have your account number handy. 5 Pay in person Please note: a handling fee may be applied for insufficient funds or returned checks. Note for commercial accounts: Commercial account requests must be accompanied by a statement from the account holder’s bank on bank letterhead indicating that the signature on the form is the approved signature for the commercial account at the bank. This letter must be signed by a bank officer. Account Holder Name (please print) _________________________ Signature ________________________________________________ Date ____________________________________________________ For a listing of authorized payment locations, call or visit us online at www.amwater.com/myh2o. John Doe 123 Main St. Anywhere, NJ 17000 6 Pay Through a Third Party If someone handles paying your bills, such as a relative, trustee or social service organization, we can send a copy of your bill, as well as any reminder, past-due and shut-off notices, to that third party. SAMPLE DOLLARS __________________________________________________________________ MEMO ____________________ *There is a third-party fee per transaction for credit card or e-check payments. 1001 Date ______________ PAY TO THE ORDER OF ___________________________________________________ CUT HERE No Stamps Required. Check Routing Number ___________________________________ Account Number Please mail your completed form to: New Jersey American Water, P.O. Box 578, Alton, IL 62002 You may also fax this form to 1-618-433-4569.
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