Please complete and sign form, print and mail to:
Village of Cary
655 Village Hall Drive
Cary, IL 60013
Email: waterbilling@caryillinois.com

I (we) request that the Village of Cary cancel my (our) automatic bank payment service. I understand that an ACH transmission can be sent up to seven (7) days prior to my due date, and that it is possible that this cancellation may not take effect until my next billing cycle.

Name on Account*

Signature*

Address on Account*

Village of Cary Water & Sewer Account Number*

Date*

Daytime Phone Number*

Name of Customer's Financial Institution*

Reason for Cancellation

Changed Bank Moving Out of Town

Service Not Working Out Other