Home Services Utilities Payment Options Automatic Payment Form Direct Payment Automatic Withdrawal Authorization Form Edit Form Date Field Name Address Phone Number Financial Institution Routing # Account # Type of Account Checking Savings Select One I am not currently participating in the Direct Payment Withdrawal Program I am currently participating in the Direct Payment Withdrawal Program and want to Change my financial institution or account number I am currently participating in the Direct Payment Withdrawal Program and want to stop participation in the program Text AreaBy clicking 'SUBMIT' you are authorizing the CITY OF CHELSEA to initiate debit entries from your account indicated above, for payment of the amount listed on your monthly utility (electric, water and/or sewer) bill. You also authorize CITY OF CHELSEA or CHELSEA STATE BANK to reverse any debits made to such account in error. This authority is to remain in full force and effect until CITY OF CHELSEA has received written notification from you of its termination in such time and in such manner as to afford CITY OF CHELSEA and CHELSEA STATE BANK a reasonable opportunity to act on it.