ACH Form

ACH-Form

Apply for Automatic Clearing House billing here.

Name(Required)

First Last

Email(Required)

Phone Number(Required)

Service Location(Required)

Street Address Address Line 2 City State ZIP Code

Where is service needed?

Billing Address(Required)

Use my Service Location Address

Street Address Address Line 2 City State ZIP Code

WDTSA Account Number(Required)

Name on Checking/Savings Acount(Required)

I WISH TO HAVE MY PAMENTS WITHDRAWN AUTOMATICALLY FROM THE FOLLOWING ACCOUNT(Required)

CHECKINGS ACCOUNT (PLEASE UPLOAD A VOIDED CHECK)

SAVINGS ACCOUNT (OBTAIN THE FOLLOWING FROM BANK)

Customer Account Number(Required)

Bank Routing & Transit Number(Required)

Upload a Voided Check(Required)

Max. file size: 4 MB.

Accepted File Types: JPG, GIF, PNG, PDF

Today's Date(Required)

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