EXPRESS PAY 






What is Express Pay?

Express Pay is a payment program that provides 
you, our customer, the option of paying your utility 
bill by automatic withdrawal from your checking or 
savings account.  

How do I join Express Pay?

Just stop by the Customer Service Center at City 
Hall and pick up an application or call our 
Customer Service Center at (623) 773-7160 or 
fax at (623) 773-7159 and we will mail or fax 
one to you.  A form may also be downloaded off the 
City of Peoria’s website at www.peoriaaz.gov.

What needs to be included with my 
Express Pay application?

We will need either a voided check from your 
CHECKING account or a pre-printed deposit 
slip from your SAVINGS account.

When do I know my application has been 
accepted?

Your billing statement will contain a message 
stating “NOT TO PAY”; the payment will 
automatically be withdrawn from your designated 
account within three (3) days of the due date 
indicated on your billing statement.  

The process may require up to two billing 
periods after submitting your Express Pay 
application to be initiated.  

Will I continue to receive a bill from the 
City of Peoria?

Yes, you will continue to receive a billing 
statement. As participants of the Express Pay 
Program, you will have a notation on your billing 
statement indicating the previous amount that was 
successfully deducted from your designated 
account, the current amount due and the due date.  
The current amount due will be deducted within 
three days of the due date indicated on your billing 
statement from your designated account.

What if I have a question regarding my 
utility bill?

Please call the Customer Service Center at (623) 
773-7160, if you ever have any questions regarding 
your bill.  You may stop or make changes to your 
Express Pay at any time.  Any stop payment or 
changes must be in writing.  Please allow at least 
ten days before the due date listed on the current 
billing statement to initiate any changes or requests.



Sign up now!!!


Saves Time & Money
*
It’s Easy & Hassle Free
*
No More Late Payment
*
BEST OF ALL – IT’S FREE

- See reverse side for “Express Pay” application - ?
Express Pay


Application

AUTOMATIC UTILITY PAYMENT AUTHORIZATION

The City of Peoria offers two automatic payment options for its utility customers.  Please complete the 
authorization at the bottom of this form designating your preference. The withdrawal from your account will 
occur within three days of the due date shown on your monthly statement. You will see this statement on your 
billing, DO NOT REMIT PAYMENT-AUTOMATIC PAYMENT PROCESSED. This indicates that you are on our 
express pay program. It may take up to two billing periods after submitting your application. Please review your 
statement immediately upon receipt.  Our office must be notified, in writing, if you would like to stop the 
automatic payment application, at least 10 days prior to the billing due date (see address at bottom of this 
page).


Customer Name:	

Utility Account Number:	

Service Address:	

Mailing Address:	
	(if different from Service Address)

Daytime Phone (____) 		Alternative Phone (____) 	


PLEASE CHOOSE ONE PAYMENT PREFERENCE AND PROVIDE REQUIRED INFORMATION

	? SUREPAY – AUTOMATIC	? SUREPAY - AUTOMATIC
	PAYMENT THRU CHECKING ACCOUNT	PAYMENT THRU SAVINGS ACCOUNT
	(A voided check must be attached)	(A voided deposit slip must be attached)
	A/C # _______________________	A/C # _________________________  

Name of Bank___________________________________	Bank’s Phone #	

Bank Address 		

City ______________________________	State _____________ Zip Code 	

You are hereby authorized and requested, until otherwise instructed, to charge to the above referenced account, 
all utility charges and fees rendered against the undersigned by the City of Peoria, as stated on the utility billing 
statement, for the service address listed above.  Utility charges may include one or more of the following 
services:  water, sewer and sanitation.

I understand that requests to discontinue or change this service must be made in writing and forwarded to the 
City of Peoria, ATTN: Customer Service Center, 8401 W. Monroe Street, Peoria, AZ 85345.


Signature: ______________________________________	Date: 	
                 (As signed on your bank account)