All applications must be received no later than November 5th to have drafting established for the December 2026 quarterly billing cycle. This authority is to remain in effect until written notice of termination is given to Arch Cape Domestic Water Supply District & Arch Cape Sanitary District’s, Utility Billing Dept., 32085 E Shingle Mill Ln, Arch Cape, OR 97102. Written notice to discontinue drafting must be received no later than the 5th of the month. Quarterly Utility bills will be mailed to utility customers on or about the 10th day of March, June, September and December should no unforeseen circumstances exist. Utility payments will be drafted from customer accounts as follows: Arch Cape Domestic Water Supply District will draft 30 days following the quarterly bill. Arch Cape Sanitary District will draft 60 days following the quarterly bill with the exception of holidays, weekends, bank closing, or other unexpected events. In that event, payment will be drafted on the next business day. Accounts will be drafted for the full balance; no partial payments can be arranged. Please fill out the information requested and return application and voided check to the Arch Cape Domestic Water Supply District & Arch Cape Sanitary District’s Billing Department at the above-mentioned address.

I hereby authorize the Arch Cape Utility Billing Department to initiate debit entries on my account with the Financial Institution indicated below.

Enter your authorized signature name below

All information provided to the Arch Cape Domestic Water Supply District & Arch Cape Sanitary District’s Billing Department will be strictly confidential and used for the intended purpose of bank drafting customer’s utility bills. No information contained on this form will be made available to other sources, other than the District’s banking institution, unless the District receives a written and signed notice from the customer.