HomeMy WebLinkAboutSurePay application
How to Participate
Complete and return the application with listed supporting documents to:
City of Iowa City
Revenue Division - SurePay
410 East Washington Street
Iowa City, Iowa 52240-1826
Your application will be processed in 2 to 3 weeks.
Note: You should submit payment for any bill that does not include the word *SurePay* in the total
balance due box.
The City will debit your checking or savings account on the bill due date. Any checking, savings, or utility account changes
will require a new SurePay application. If you have any questions, call the Revenue Division at 319-356-5066.
City of Iowa City SurePay Application (FI) Financial Institution to be charged.
Name (as it appears on utility account): ___________________________
Service address: _____________________________________________
Utility account number: __________________________________________
Telephone number: _____________________________________________
Bank Name: ___________________________________________
City/State: ____________________________________________
Bank routing number: ____________________________________
Bank account number: ___________________________________
Please check one and provide supporting document
Checking (provide voided check)
Savings (provide savings account deposit ticket encoded with your account
number by your bank or a letter from your bank listing your account
number and bank routing #)
I (we) authorize The City of Iowa City to initiate debit entries to my (our) account indicated and for the financial institution to debit the same to such account.
Name #1 Name #2:
Signature #1: Signature #2:
If bank account name is different from utility account name – Office Use Only PROCESS EFFECTIVE
Both signatures required.) DATE: DATE:
Date:
Finatreas/forms/SurepayApplication.doc Rev. May. 2018
The City of Iowa City provides
SurePay
Sign up for SurePay and pay your City utility bill with direct automatic payments from
your financial institution. The payments won't be late, lost or forgotten.
● No checks ● No stamps to buy
● No envelope needed ● No post office trips