Automatic Payment Form | Fountain Hills Sanitary District

Instructions Please fill out ALL fields and submit one time when finished. You will receive a confirmation email when you submit the form. Please allow up to two weeks to process this request. Thank you!
FHSD Book Number *
FHSD Account Number *
Customer Full Name *

Street Address *
Apt, Suite, Bldg. (optional)
City *
State *
ZIP *
Email *
Financial Institution Authorization I authorize the following institute to accept the funds transfers and charge my checking or savings account shown below to pay Fountain Hills Sanitary District sewer bills or to credit my account if it is necessary to make corrections. This authorization is in effect until I contact FHSD in writing.
Financial Institution Name *
Bank Routing Number *
Bank Accounting Number *
Type of Account
CheckingSavings
Customer Authorization *
By checking this box, you agree to the processing and are an authorized signer on the bank account.
Today's Date *
IMPORTANT Upload a photo of a voided check or a statement from your financial institution with the Routing and Account Numbers on it. Failure to include one could delay your enrollment.
File Upload for Photo of Voided Check or Statement
Name of authorized signer on bank account *

16941 E. Pepperwood Circle
Fountain Hills, AZ 85268
Phone: 480-837-9444
Fax: 480-837-0819
Email Us