East Dubuque, IL · Jo Daviess County
Authorization Agreement for ACH Debits
This agreement lets East Dubuque utility customers authorize the city to debit a checking or savings account for utility payments.
What this form is
Utility account holders use this agreement to authorize the City of East Dubuque to debit a selected checking or savings account. It requests the utility account number, account holder and service details, depository information, routing and account numbers, and a signature and date. The form says to return it with a deposit slip or voided check.
Who needs it
A customer with an East Dubuque utility account who wants payments debited from checking or savings should complete and return this agreement.
How to submit it
The form says to return it to the company with a deposit slip or voided check. Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the signer just signs and dates it, and the form requests a deposit slip or voided check as an attachment.
How to submit this form
- 1
Download The Form
Download the Authorization Agreement for ACH Debits.
- 2
Complete The Agreement
Enter the utility account and service details, select checking or savings, provide depository and account information, then sign and date.
- 3
Gather An Attachment
Include a deposit slip or voided check, as directed on the form.
- 4
Return It To The Company
Return the completed agreement and attachment to the company; the form does not provide a specific address.
Frequently asked questions
- Do I need a notary for this ACH debit authorization?
- No. The signer signs and dates the agreement without a notary. The form requests a deposit slip or voided check, but does not say either must be notarized.
- How do I submit the ACH debit authorization?
- Return the completed form to the company with a deposit slip or voided check. The form does not give a specific department or delivery address.
- What information does the agreement request?
- It asks for utility account and service details, contact information, checking or savings selection, depository details, routing and account numbers, and the account holder’s signature and date.