Etna, CA · Siskiyou County
Utility Direct Debit Form
Etna utility customers use this form to authorize monthly payment deductions from a bank account and optionally request paperless billing.
What this form is
This form authorizes the City of Etna to deduct the outstanding balance on a utility account from a bank account on the 10th of each month. The customer provides account-holder and contact details, bank account information or a voided check, and a signature and date. It also offers an option to request paperless billing and explains notice, insufficient-funds, and cancellation conditions.
Who needs it
Etna utility customers who want the city to deduct their account balance monthly from a bank account can complete this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed and dated without a notary; the signer may attach a voided check, but the form does not require a notarized or sworn attachment.
How to submit this form
- 1
Download The Form
Download the City of Etna Utility Direct Debit Form.
- 2
Complete The Form
Enter the utility account holder and contact details, bank account information, and whether you want paperless billing.
- 3
Gather An Optional Attachment
Attach a voided check if you prefer not to enter the bank account details.
- 4
Sign And Date
Sign and date the authorization.
- 5
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the Utility Direct Debit Form authorize?
- It authorizes the City of Etna to deduct the outstanding balance on a utility account from the customer's bank account on the 10th of each month.
- What information do I need to provide?
- Provide the account holder's name, street address, phone number, bank account holder name, routing number, and account number. You may attach a voided check instead of entering bank details.
- Do I need a notary for the Utility Direct Debit Form?
- No. The signer signs and dates the form; a voided check may be attached, but no notarized or sworn attachment is required.
- How do I submit the Utility Direct Debit Form?
- The form does not specify a submission method. Submit it to the city department named on the form; check the city website for current contact details.