Do I need a notary for the Direct Debit Authorization Form?

No. The form asks for signatures and a date, not notarization. Attach a voided check; the document does not say the check must be notarized.

How do I submit the Direct Debit Authorization Form?

Attach a voided check and return the form to the Village of Palos Park at the Kaptur Administration Center, 8999 W. 123rd Street, Palos Park, IL 60464.

What information does the form ask for?

It requests financial institution and bank account details, checking or savings account type, utility bill account number, recipient signatures and printed names, address, phone number, and date.

When will automatic payments begin?

The form says the first electronic transfer takes time to process. Your utility bill will show “AUTO PAY” in the “AMOUNT ENCLOSED” box once the account is activated.

Palos Park, IL · Cook County

No notary required

Direct Debit Authorization Form

Palos Park utility customers use this form to authorize automatic utility bill payments from a checking or savings account.

What this form is

This form authorizes the Village of Palos Park to withdraw utility bill payments from a checking or savings account on normal billing dates. To enroll, utility customers provide bank and utility account details, sign and date the authorization, and attach a voided check. The form says direct debit continues until the Village receives written notice to end it, and that the Village may terminate the agreement.

Who needs it

Palos Park utility customers who want their bills paid automatically by electronic transfer from a checking or savings account need this form.

How to submit it

Attach a voided check and return the form to the Village of Palos Park, Kaptur Administration Center, 8999 W. 123rd Street, Palos Park, IL 60464.

About notarization

This form is signed and dated without a notary; attach a voided check, which the document does not say must be notarized.

How to submit this form

1
Download The Form
Download the Direct Debit Authorization Form.
2
Complete The Form
Enter the requested bank and utility account information, then sign and date the authorization.
3
Attach A Voided Check
Include a voided check with the completed form.
4
Return It To The Village
Return the form and voided check to the Village at 8999 W. 123rd Street, Palos Park, IL 60464.

Frequently asked questions

Do I need a notary for the Direct Debit Authorization Form?: No. The form asks for signatures and a date, not notarization. Attach a voided check; the document does not say the check must be notarized.
How do I submit the Direct Debit Authorization Form?: Attach a voided check and return the form to the Village of Palos Park at the Kaptur Administration Center, 8999 W. 123rd Street, Palos Park, IL 60464.
What information does the form ask for?: It requests financial institution and bank account details, checking or savings account type, utility bill account number, recipient signatures and printed names, address, phone number, and date.
When will automatic payments begin?: The form says the first electronic transfer takes time to process. Your utility bill will show “AUTO PAY” in the “AMOUNT ENCLOSED” box once the account is activated.

Need something notarized?

This Direct Debit Authorization Form doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.