Authorization Agreement for Preauthorized Electronic Withdrawals

The ACH automatic withdrawal payment option is a free, convenient, hands-free way to ensure you never miss a payment. The same amount is withdrawn from your checking or savings account on the last business day of each month. 

Please complete the ACH Authorization and mail or drop in our box at the City Market Customer Service counter. You can also email to Tara Espinoza: tara@buenavistasanitationdistrict.com

I hereby authorize Buena Vista Sanitation District to initiate debit entries to my Checking/Savings account for the purchase of paying the monthly sewer bill to Buena Vista Sanitation District.

Said debit will occur the last business day of the month.

Month to Begin (required)

Sewer Service Account Number (required)

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Service Address

Address Line 1

Address Line 2

City

State

Zip Code

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Call 719-395-8095 during business hours to provide bank routing and account numbers.

Acknowledgements: Check each box to indicate you have read each statement. (required)

By choosing the ACH method of payment you will receive an e-bill indicating "Draft Bill".

Returned items from the bank may be subject to a $25 fee.

I understand that if an erroneous debit is made to my account, Buena Vista Sanitation District and the financial institution are authorized to reverse the entry and make any adjustments necessary to my account to correct the erroneous entry. This authorization is to remain in full force and effect until I provide written notice to cease to the Buena Vista Sanitation District and the depository (Bank or Credit Union) institution has reasonable opportunity to act on it.

First Name

Last Name

Phone

Email

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

Date (required)

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