TREMPEALEAU MUNICIPAL UTILITIES

24455 3rd Street, P.O. Box 247 Trempealeau, WI 54661 Phone: 608-534-6434 Fax: 608-534-6280 Email: tremplo@centurytel.net ELECTRONIC BILL PAYMENT
Trempealeau Municipal Utilities (TMU) coordinates with your bank and automatically withdraws the money for your electric, water, and sewer bill through your bank, savings & loan, or credit union account.

- Sign up by filling out this application, signing the form, and returning with a voided check. - Cancel at any time by notifying us in writing. - Pay your bill the month you sign up and automatic payments will start the next month. - Any changes to your bank account information needs to be submitted to TMU by the 15th of the month. - You will still receive a normal TMU bill and it will say "Paid Electronically" to show automatic payment. - Payment will be made 20 days after the billing date shown on your bill. - If you have any questions regarding this new service or your utility bill, please give us a call at 608-534-6434.

Application for Electronic Payment Plan

Fill out this authorization agreement, sign, and mail it along with a VOIDED CHECK.
Please PRINT all of the following information: I authorize the financial institution listed below to charge my Checking/Savings Account and remit payment for my monthly utility bill to Trempealeau Municipal Utilities. Type of Account: BANK INFORMATION: Name of Financial Institution Bank Account Number Checking Account Savings Account

Bank Routing Number (Between : and : on bottom of check) CUSTOMER INFORMATION:

Account Holder's Name

Utility Account Number (from your TMU bill)

Account Holder's Address

Account Holder's Phone Number

Authorized Signature

Date

APPLICATIONS WILL NOT BE PROCESSED WITHOUT A SIGNATURE OR A VOIDED CHECK.