Complete and submit the form below. The City will process your application and notify your financial institution. Auto Pay will be effective as of your next bill. Any current balance must be paid using your current payment method.

With Auto Pay, your bank account will be debited on the utility bill due date; your utility bill will be sent by mail or e-bill notification on the billing date and will say "DO NOT PAY." For more information, contact the Utility Billing Department at 319.248.1715, or email utilitybilling@coralville.org

Your Information

Customer Name on Account*

Utility Account Number*

Service Address*

Daytime Phone Number*

Email Address*

Required Bank Account Documentation*

To complete this application, I will provide a voided check with my preprinted name or bank letter on bank letterhead that includes applicant's name, bank routing number, and bank account number.

Drop this off at:
City of Coralville Utility Billing
Coralville City Hall
1512 7th Street
Coralville, Iowa 52241

Or, mail to:
City of Coralville Utility Billing
P.O. Box 5127
Coralville, IA 52241

Authorization*

By submitting this form, I authorize the City of Coralville to initiate various debit entries to my checking / savings account indicated above and my Financial Institution to debit such account. This authority will remain in full effect until I notify the City of Coralville in writing of its termination.

Please check one*

Checking

Savings

Additional Comments