Form Center

2. 

3. 320 Alexandria Blvd. Oviedo FL 32765

   Phone: (407) 971-5535

   Fax: (407) 971-5806

   Office Hours: Monday-Friday 8 a.m. - 5 p.m.

5. Instructions

   1. Provide all of the requested information below.

   2. Sign your application.

   3. Attach a VOIDED check from your financial institution.

7. Name
8. Email Address
10. Service Address
12. DRIVER'S LICENSE NUMBER
13. SOCIAL SECURITY #
15. DATE OF BIRTH
    DATE OF BIRTH
16. UTILITY ACCOUNT NUMBER
18. NAME OF FINANCIAL INSTITUTION
20. ACH ROUTING NUMBER
22. BANK ACCOUNT NUMBER
24. CHECK ONE:

    1. New Application
    2. Change of Bank
    3. Change Account Number
    4. Terminate EZ Pay
26. Pick date of Termination
    Pick date of Termination
28. TERMINATION MAY TAKE 5-10 BUSINESS DAYS
30. ACCOUNTY

    1. CHECKING
    2. SAVINGS

32. A VOIDED CHECK FOR CHECKING ACCOUNTS OR DEPOSIT SLIPS FOR SAVINGS ACCOUNTS MUST BE ATTACHED. IF USING A SAVINGS ACCOUNT, PLEASE VERIFY YOUR ROUTING NUMBER AND ACCOUNT NUMBER DIRECTLY WITH YOUR FINANCIAL INSTITUTION.

34. Upload VOIDED check here

36. This authority is to remain in full force and effect until  the City  of Oviedo has received notification from  me of its cancellation in such time and such  matter as to  afford  the City  of Oviedo and the financial  institute a reasonable opportunity to act on  it.  

    • The City of Oviedo is not responsible for incorrect Routing, or incorrect Account Numbers 
    • PLEASE NOTE: When your Automatic Bill Pay withdrawal is active, a message will appear on your Utility Bill stating, “Bank Draft-Do Not Pay”.

    I hereby  authorize the City  of Oviedo to initiate debit entries and  to initiate, if necessary, credit entries and adjustments for any debit entries in error to  my account indicated above and the  financial institution named above to debit/credit the same to such account.  

38. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
40. Electronic Signature
41. Date
    Date

43. The City of Oviedo does not accept liability for transmission of this form with confidential information. Email over the internet is NOT a secure medium and privacy cannot be assured. Fax: 407-971-5806

Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field