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Authorization Agreement for PreAuthorized Payments

  1. Information
    The City of Dyersville offers automatic bank withdrawal for payment of the water, sewer and solid waste accounts. Simply complete this form. You will receive your bill each month stating the amount that will be withdrawn from your account on the 20th. If you have any questions, please contact us. Please note the information you provide below will be emailed to the City of Dyersville. If you are not comfortable submitting you bank information online, a form in available for you to print and mail or deliver to city hall.
  2. Authorization*
  3. Checking or Saving Account*
  4. Leave This Blank:

  5. This field is not part of the form submission.