Direct Payment Application

By completing this application form, I authorize the City of Irwin to initiate electric debit entries to my

* Indicates required field

Choose One *

Checking Account Savings Account

for payment of my utility bill.

Name *

First

Last

Phone Number *

Sevice Address *

Line 1

Line 2

City

State

Zip Code

Country

Account Title *

Financial Institution Name *

Financial Institution City and State *

routing number *

account number *

Please upload and image of a voided check here *

Max file size: 20MB

By typing my full name here, I agree this takes place of my physical signature. *

Date *

Submit

If you need to request utility services first, please click HERE.

All applications can be completed by hand if you prefer. Please pick up the form(s) from City Hall.