Paperless Billing & Autopay Enrollment Form

CUSTOMER INFORMATION

Please note validation has been disabled on this form. This setting can be changed under "Options -> General Options".

Customer Name

RPU Account Number

Service Address

City

Zip Code

Contact Phone Number

Email Address

Is your mailing address different than the service address?

Yes

Terms & Signature

BY TYPING MY FIRST AND LAST NAMES IN THE BOX BELOW, I AM SIGNING THIS FORM AND HEREBY REQUEST RPU TO ENROLL MY ACCOUNT IN THE OPTIONS I HAVE SELECTED BELOW. THE AUTHORIZATIONS ARE TO REMAIN IN EFFECT UNTIL RPU RECEIVES NOTIFICATION FROM ME TO CANCEL.

Customer Signature

Date

PAPERLESS BILL

I understand I will no longer receive my monthly utility bill via postal mail. I can log in to view my utility bill via my.rpu.org.

My building type is:

Email Alert: Email Address:

Multi-Family (buildings with two or more units)

NEIGHBORS CHIPPING IN
RPU’s Neighbors Chipping In program collects donations to help struggling individuals and/or families in our community pay their utility bill. It’s easy to give with a recurring monthly donation (donations can be cancelled at any time).

AUTOPAY
I request RPU and authorize the financial institution named to initiate debit entries to my account to pay my monthly utility bill.* These payments will be deducted on my due date.
* Please note that the maximum amount allowed for checking and savings is $60,000 per transaction. In addition, the maximum number of payment transactions allowed on an account is five (5) per month.

WE VALUE YOUR PRIVACY! To protect your privacy, any attached voided checks or deposit slips will be destroyed.