Goreville, IL · Johnson County
Recurring ACH Payment Authorization
This form authorizes the Village of Goreville to debit a resident’s checking or savings account monthly for a water and/or sewer bill.
What this form is
The Recurring ACH Payment Authorization lets an account holder authorize monthly electronic payments for a Village of Goreville water and/or sewer bill. It requests billing and contact details, bank and account information, the payment amount, and the account holder’s signature and date. The form states that authorization continues until canceled in writing and describes notice requirements for account changes or cancellation.
Who needs it
A Village of Goreville water or sewer customer who wants to pay the monthly bill by recurring debit 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 without a notary; the account holder just signs and dates the authorization.
How to submit this form
- 1
Download The Form
Download the Recurring ACH Payment Authorization PDF.
- 2
Complete The Form
Enter your billing and contact details, select checking or savings, provide the requested bank information and payment amount, and sign and date.
- 3
Gather Attachments
The document does not list any required attachments.
- 4
Submit To The City
Follow submission instructions provided by the city; the form itself does not specify how to submit it.
Frequently asked questions
- Do I need a notary for the Recurring ACH Payment Authorization?
- No. The form calls for the account holder’s signature and date, with no notary block or notarized attachment mentioned.
- How do I submit the Recurring ACH Payment Authorization?
- The form does not give submission instructions. Submit it to the city department named on the form; check the city website for current contact details.
- What payments does this authorization cover?
- It authorizes a recurring monthly ACH debit for the monthly Village of Goreville water and/or sewer bill.
- What information does the form ask for?
- It asks for billing and contact information, checking or savings selection, account and bank details, the payment amount, and the account holder’s signature and date.