Sign Up for Automatic Withdrawal

Fill, print and sign the form below send to PO Box 62, Henryville, IN 47126 or drop them by our office at 104 E. Main. There is a drop box to the right of the entry for after-hours drop-off. You can also email completed forms to: henryvillesewer (at)

Please note, do NOT fill out the cancellation portion of the form unless you already have autodraft set up and would like to cancel. Please just print the first two pages of the form, ignoring the third page.

Automatic Payment Form (print first two pages only)