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Village AutoPay Application

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I hereby authorize the Village of Hampshire and the financial institution listed above to debit my account on the scheduled due date of the bill to pay for my utility bill. Each payment will be the same as if it were personally signed and authorized by me. The Village of Hampshire reserves the right to terminate this payment plan or my participation with written notification. I am responsible for paying my utility bill to the Village of Hampshire until my bill indicates that my direct debit payment program is established. My bill will note when the direct debit begins. I further understand that I will continue to receive a bill for my records.