Palos Park, IL · Cook County
Direct Debit Change Authorization Form
The form authorizes the Village of Palos Park to change direct debit information for a utility account and is completed by the account holder.
What this form is
Use this form to authorize the Village of Palos Park to change the direct debit information for a utility account. It requests the account holder’s contact and service details, current and revised financial institution and account information, and a signature and date. Attach a voided check when returning the form.
Who needs it
A utility account holder who wants the Village of Palos Park to change the bank or account information used for direct debit payments needs this form.
How to submit it
Attach a voided check and return the completed form to the Village of Palos Park, 8999 W. 123rd Street, Palos Park, IL 60464. Allow sufficient time for processing.
About notarization
This form is signed and dated without a notary; attach a voided check, and the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the Direct Debit Change Authorization Form.
- 2
Complete The Form
Enter the utility account and contact details, current and revised bank information, then sign and date the form.
- 3
Attach A Voided Check
Include a voided check with the completed form.
- 4
Submit To The Village
Return the form to the Village of Palos Park at 8999 W. 123rd Street, Palos Park, IL 60464.
Frequently asked questions
- What does the Direct Debit Change Authorization Form do?
- It authorizes the Village of Palos Park to change direct debit information for a utility account and permits withdrawals and related correction or adjustment entries.
- What should I include with the form?
- Complete the current and revised financial institution and account information, sign and date the form, and attach a voided check.
- Do I need a notary for the Direct Debit Change Authorization Form?
- No. This form is signed and dated without a notary. Attach a voided check; the signer just signs and dates the form.
- How do I submit the Direct Debit Change Authorization Form?
- Return the completed form with a voided check to the Village of Palos Park, 8999 W. 123rd Street, Palos Park, IL 60464. Allow sufficient time for processing.
Need something notarized?
This Direct Debit Change Authorization Form doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.