Authorization for SurePay Automatic Bill Payment Service

SurePay will take effect on the first monthly utility bill generated after the SurePay Authorization is received and processed by the City of Mesa. Any past due or current balance outstanding at this time must be paid manually.  If you would like to sign up for recurring credit card payments please log in to 'My Utility Account' or call us at 480-644-2221.    A 2.37% Service Fee will be charged when a credit or debit card is used for utility bill payments. 

Customer Infomation 

*Last Name 
*First Name
*Utility Account Number
*Daytime Phone Number
*Email Address
Service Address
*Street Address  Unit Number  
*City        *State       *Zip Code   

Mailing Address (if different than service address)
Street Address or PO Box  Unit Number  
City        State       Zip Code   

I authorize City of Mesa to arrange a SurePay Automatic Payment Program for me and to initiate electronic fund transfers to pay the full utility bill for the customer named above.

 I also authorize the following financial institution to accept the fund transfers and charge my checking or savings account shown below to pay the City of Mesa utility bills or to credit my account if it is necessary to make corrections.  To cancel this authorization, I will contact the City of Mesa in writing or by phone.

Financial Institution

Payer name:
Account Type:

Bank routing number (9 digit number on bottom left of check)

Bank account number

(For checking accounts, please include all numbers from the lower left side of your check.  For savings accounts, please contact your financial institution for the correct routing and account numbers.)

  By selecting eBill, you will receive notification that your City of Mesa utility bill is available online in addition to the amount due and due date.  Your account can be accesssed through the following web address:
If you would prefer text eBill notifications (see sample), enter your mobile phone and service provider below:
  Please choose one:
Mobile phone number:    Service Provider:   
      **Text messaging and data rates from your mobile phone provider may apply  

.       List 3 dates, between the 1st and the 31st of each month, when you prefer to pay your utility bill.       
        1.       2.        3.   

        (Due date availability is dependent on your scheduled read date, and all requested dates may not be available.)

        Please deduct the following amount in addition to my bill amount:
       $   Monthly contribution of your choice (All donations are allocated to local non-profit agencies serving Mesa residents.)

(We will round up your utility bill amount to the nearest whole dollar amount. For example, if your bill amount is $42.37, your round up contribution would be $.63 for a total of $43.00.  All donations are allocated to local non-profit agencies serving Mesa residents.)