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AUTOMATIC BILL PAYMENT ENROLLMENT FORM Name as shown on your bill Service Address City/State/Zip Mailing Address if different Customer/Account Number Daytime Phone Bank Name Bank Routing Number Checking/Savings Account Number attach a VOIDED check or savings deposit slip with this form OR Credit Card Expiration Date I hereby authorize the Hillsdale Board of Public Utilities to deduct my payment from the account listed above. I understand that I am in full control of my payment and that I can...

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