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2. Name on Tax Bill*
4. Parcel Number*
6. Service Address*
8. Mailing Address (if different)
10. Daytime Phone *
11. Email*
15. Season*

    1. Summer
    2. Winter
    3. Both
16. Year*
    -- Select One --2022
18. Date to Be Pulled
    Pick only one per season. Leave blank if not having payment pulled from that season.
20. Summer 2022

    1. July 22, 2022
    2. August 19, 2022
21. Winter 2022

    1. December 16, 2022
    2. January 20, 2023
25. Account Type*

    1. Checking
    2. Savings
27. Bank Name*
29. Routing Number*
31. Bank Account Number*
33. Your Authorization*

    1. By signing this form, I certify that I am an owner of the account authorized to sign this document.

35. I certify that the parcel numbers are accurate and authorize the City of East Lansing to deduct my payment for taxes directly from the checking or savings account indicated above on the date of choice indicated and authorize my bank to make the payments directly to the City of East Lansing without further authorization. This authorization is for tax year 2022 ONLY and will not draft again after the dates indicated. If I decide to terminate this payment, I may do so at any time by notifying the City of East Lansing at least 10 days in advance of the chosen payment draft date. I further agree that if any such withdrawal and payments should be dishonored, intentionally or inadvertently, that I will be charged a $35 rejected payment fee and in no case will the City be liable for fees charged by my bank for any other resulting dishonored payments as a result of the use of this service. Further penalties may apply if the payment due is not received by the City on the due date. Please note: Forms and any change in account information must be received at least one week prior to the date chosen to draft. The City may terminate this service at any time.

Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field