Patterson, GA · Pierce County
Authorization for City of Patterson Direct Payment via ACH
This form authorizes the City of Patterson to debit a checking or savings account for direct payments, including payments associated with water and sewer service.
What this form is
This authorization form lets a signer approve electronic debits from a checking or savings account to the City of Patterson, with possible credits to correct erroneous debits. It asks for the account holder’s name and signature, depository and account details, debit amount or calculation method, and debit dates or frequency; it also includes fields for revocation instructions and notice.
Who needs it
A person authorizing the City of Patterson to make direct ACH debits from a checking or savings account should 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; it does not identify any attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download The Form
Download the City of Patterson ACH direct payment authorization PDF.
- 2
Complete The Authorization
Enter the account holder’s name, account details, debit amount or method, and payment dates or frequency.
- 3
Sign And Date
Sign and date the authorization.
- 4
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 ACH authorization form do?
- It authorizes the City of Patterson to electronically debit a checking or savings account for a stated amount or method and schedule, with possible credits to correct erroneous debits.
- What information does the form ask for?
- The form asks for the signer’s name and signature, depository name, routing and account numbers, debit amount or calculation method, and debit dates or frequency.
- Do I need a notary for the ACH authorization form?
- No. This document is signed and dated without a notary, and it does not identify an attachment or related step that must be notarized or sworn.
- How do I submit the ACH authorization form?
- Submit it to the city department named on the form; check the city website for current contact details, because the document does not provide a submission address or method.
Need something notarized?
This Authorization for City of Patterson Direct Payment via ACH doesn’t need a notary — but if you have another Patterson form that does, a commissioned online notary can help.