Checking Auto Withdrawal

To sign up for auto withdrawal from your checking account, please fill out the webpage below. If you would rather mail in your auto withdrawal application, please print and mail the form.

Water Account Number (format: 000-00000-00)

Name on Service Account *

Phone Number *

Email *

Service Address *

Address Line 1

City

State

Zip Code

Name of Payee *

Name of Bank or Credit Union *

Checking Account Number *

Routing Number *

Monthly Date for Auto Withdrawal *

5th
20th

E-Billing *

Please enroll me in e-bill notifications!
Please continue to mail me a paper bill.

Electronic Signature *

By selecting the "Submit" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature and consent to be legally bound by this Agreement's terms and conditions. Your signature authorizes Diablo Water District to make monthly withdrawals from your checking account in the amount of your current water bill, and that all information is true and correct.