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Helendale Community Services District 
26540 Vista Rd., Suite B
P.O. Box 359
Helendale, CA 92342

Phone  760-951-0006
Fax     760-951-0046
e-mail  mail@helendalecsd.org
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Auto Payment Enrollment


Helendale California Community Services District
Helendale Community Services District logo
Automatic payments will not begin until the next billing cycle.

*Automatic payment will be debited on the last business day of each month

If using a credit card you may choose the business day closest to the 15th or 31st of each month, and the fee is $2.50 per month

All past due balances must be paid in full in order for automatic payments to commence.
Bank Account
Credit Card - I am aware a $2.50 convenience fee will be added for this option
OR
Routing Number
Repeat Routing Number
Bank Account Number
Repeat Bank Account Number
I
:
I
:
Credit Card Number Number
Expiration
Automatic Payment Authorization (please read then agree by checking the box - REQUIRED)
Automatic Payment - Past Due Balances
EBilling (recommended)
Checking
Savings
Account type:
Payment Type (select only one)
I authorize Helendale Community Services District (HCSD) to collect payment of my water bill by initiating debit entries (deductions) to the bank account or credit card indicated above. I understand that this authorization will remain in effect until I cancel it in writing or HCSD has cause to cancel it. I agree to notify HCSD in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the periodic payment date falls on a weekend or holiday, I understand that the payment may be executed on the next business day. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the noted periodic transaction date. I understand that if there are insufficient funds in my account on the day of the withdrawal, a Non-Sufficient Funds (NSF) charge of $31.00 will apply. In addition, my account will be considered past due and late penalties will apply. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form. I understand that automatic payments will not begin until the next billing cycle.
I understand accounts with a past due balance will not be enrolled in automatic payments. Please make sure all past due amounts have been paid in full before enrolling in automatic payments.
I request for an email copy of my bill to be sent to the email address I listed above
Enter these 5 characters as shown. Use CAPS
Customer Name(s):
Service Address:
Financial Intitution Name:
CREDIT CARD ONLY!  Please choose the business day to bill  (Bank payment skip this)
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Helendale CSD Account #:
Phone Number (Required):
Email (Required):