Do I need a notary for the Direct Debit Payment Cancellation Form?

No. The form has a signature line but no notary block; the signer just prints their name and signs the form.

How do I submit the Direct Debit Payment Cancellation Form?

Return it to the Village of Palos Park at 8999 W. 123rd Street, Palos Park, IL 60464, or fax it to 708-448-9542.

What information does the cancellation form ask for?

It asks for your first and last name, utility billing account number as it appears on your statement, service address, phone number, printed name, and signature.

When does direct debit cancellation take effect?

The form says that if the request is made several days before the utility bill is processed, cancellation will be effective with the next utility billing.

Palos Park, IL · Cook County

No notary required

Direct Debit Payment Cancellation Form

Palos Park utility customers use this form to request cancellation of direct debit payments from their utility billing account.

What this form is

This form lets a Palos Park utility customer request cancellation of direct debit payments for a utility billing account. It asks for the customer’s name, account number, service address, phone number, printed name, and signature. The form says requests made shortly before a utility bill is processed may take effect with the next utility billing.

Who needs it

Palos Park utility customers who want to cancel direct debit payments for their utility billing account need this form.

How to submit it

Return the completed form to the Village of Palos Park, 8999 W. 123rd Street, Palos Park, IL 60464, or fax it to 708-448-9542.

About notarization

This document is signed without a notary; the signer just prints their name and signs the form.

How to submit this form

1
Download The Form
Download the Direct Debit Payment Cancellation Form.
2
Complete The Form
Enter your name, utility billing account number, service address, and phone number.
3
Sign The Form
Print your name and sign the form.
4
Send It To The Village
Return the form to the Village address listed or fax it to 708-448-9542.

Frequently asked questions

Do I need a notary for the Direct Debit Payment Cancellation Form?: No. The form has a signature line but no notary block; the signer just prints their name and signs the form.
How do I submit the Direct Debit Payment Cancellation Form?: Return it to the Village of Palos Park at 8999 W. 123rd Street, Palos Park, IL 60464, or fax it to 708-448-9542.
What information does the cancellation form ask for?: It asks for your first and last name, utility billing account number as it appears on your statement, service address, phone number, printed name, and signature.
When does direct debit cancellation take effect?: The form says that if the request is made several days before the utility bill is processed, cancellation will be effective with the next utility billing.

Need something notarized?

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