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EZPAY Form

Yes, I want to sign up for the Mishawaka Utilities EZ Pay plan!

Please fill in the following fields and submit this form once completed. Requests will be processed in the order they are received and could take up to 2 weeks to be completed. Additional information about ezpay can be found on our website here: http://mishawaka.in.gov/ezpay.

Name as it appears on your bill*

MU Account Number*

Address Line 1:*

Address Line 2:

City:*

State:*

Zipcode:*

Service Address*

Phone Number*

Email*

Yes No

Would you like to receive your bill via email?*

Name of your Bank or Financial Institution

City:*

State:*

Bank City,State

The activation process could take 1-2 weeks to complete.

*ACH guidelines require that the name on your checking account and on your MU account must match.

Date*

Signature

Please attach a voided check