YES! I would like to participate in the Village of Bloomfield's free Direct Debit Payment Program and make my water and sewer payments and/or taxes automatically.
I authorize the Village of Bloomfield to initiate entries to my checking/savings account for my water and sewer payment each quarter to pay my bill automatically. This authority will reamain in effect until I notify you in writing to cancel it in such time as to afford the Village of Bloomfield reasonable opportunity to act on it. I can stop payment of any entry by notifying my financial instutition 3 days before my account is charged.
NOTE: After submitting this application you must bring a voided check for a checking account or a savings deposit ticket for a savings account to the Village office for this application to be fully processed.
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