EZ Pay Sign Up

EZ Pay Form

* Indicates required field

Select One *

New EZ Pay Changing existing EZ Pay

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

GPSD Account Number *

Type of Account *

Checking Savings

Name of Bank or Financial Institution *

Routing Number *

Account Number *

Upload Either Copy of a Voided Check (Checking) or Bank Statement (Savings) *

Max file size: 20MB - Only PDFs and Image Files (jpg, png, heic, etc) accepted.

AUTHORIZATION
I hereby authorize Greater Peoria Sanitary District to instruct my bank or the financial institution named in this
application to make my Greater Peoria Sanitary District bill payments from the account listed. I understand that I am
in full control of EZ-Pay payments. I may discontinue enrollment at any time with written notice to GPSD. Both GPSD
and the financial institution reserve the right to terminate this payment plan and/or my participation in it.

Points to remember when enrolling in GPSD's EZ-Pay Program:
* Your account must have a zero balance before enrolling in this program.
* This entire authorization form must be completed and signed.
* A copy or voided check must be included.
* We must receive written verification to discontinue the EZ-Pay program.
* Any payments returned by the bank will be subject to a $30.00 service fee.
* You will continue to receive a regular billing statement that will show the amount to be deducted from your bank
account. This amount will be deducted on approximately the 10th of the month after the invoice date.
For example, if your account is billed on March 23rd, your bill amount will be deducted on approximately
April 10th.

If you have any questions, please call Customer Service at (309) 272-4804.

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