ACH Form

Are you signing up for or canceling auto-debit?(Required)

Signing up

Canceling

Your Name(Required)

First Last

Email(Required)

Service Address(Required)

Service Address 2

City

State

Zip code(Required)

Contact phone number(Required)

Utility Billing Account Number(Required)

Up to 9 digits, no dashes

Please upload a blank, voided check in format JPG, PNG or PDF(Required)

Accepted file types: jpg, pdf, png, Max. file size: 5 MB.

Applicant acknowledges and agrees to the terms below(Required)

I certify that I am over 18 and agree that my information is true, complete, and accurate. I understand that by submitting this form, the information provided is considered a public record except for information considered exempted, pursuant to Chapter 119 of the Florida State Statute.

I understand and agree that as a condition to receiving utility service, I will be subject to the provisions of resolution 2017-04, as amended from time to time by the district.

I understand I am responsible for placing a refundable deposit to start service; the bill is due on the 19th of every month, and if a payment is not received, a $25 penalty will be accessed.

I understand I will be charged for each payment that cannot be processed due to insufficient funds, a closed account, a returned ACH, online bill pay, or the NSID online portal.

I understand that if my bank or financial institution does not honor my payment, my utility account will assess a late penalty (based on the check amount), and my utility service may be disconnected for nonpayment. *Please note that the Financial Institution may also charge for payments returned from the bank for insufficient funds*

I acknowledge I have reviewed the terms above. I understand it contains important information regarding policies and procedures in accordance with NSID. I further understand that NSID has the right to modify and change any and all such rules and regulations.

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North Springs Improvement District

ACH Form

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North Springs Improvement District

Winner of 2022, 2021, 2019 & 2016 Water Fluoridation Quality Award

WINNER OF THE 2021 PLANT OPERATIONS EXCELLENCE AWARD

Winner of AWWA Award - Most Improved WTP Class A Award for 2024

Winner of the 2019 Government Technology’s AT&T Special Districts Awards - Government Technology Innovation