Lincolnshire, IL · Lake County
Automatic Utility Pay Agreement
Lincolnshire utility customers use this agreement to authorize automatic bank-account deductions for water and sewer bills.
What this form is
This agreement lets a water and sewer customer authorize the Village of Lincolnshire to deduct bill payments from an approved bank account on each bill’s due date. To enroll or change enrollment, complete and sign the agreement and provide a voided check; customers using savings should include a deposit slip. It asks for utility account and contact details, financial institution and account information, payment type, and the signer’s signature and date.
Who needs it
Water and sewer customers who want to start or change automatic payments from a checking or savings account should complete this agreement.
How to submit it
Return the signed agreement and voided check to the Village of Lincolnshire, 1 Olde Half Day Road, Lincolnshire, IL 60069, or leave them in the drop-box outside Village Hall. You can also fax the documents to 847-883-8608, Attn: Finance.
About notarization
This agreement is signed and dated without a notary; attach a voided check, or a deposit slip if using savings, and no notarized attachment is mentioned.
How to submit this form
- 1
Download The Agreement
Download the Automatic Utility Pay Agreement PDF.
- 2
Complete And Sign
Fill in the utility, contact, and bank account details, select the account and enrollment options, then sign and date the agreement.
- 3
Gather The Attachment
Include a voided check, or a deposit slip if you are using a savings account.
- 4
Submit To The Village
Return the documents to the Village address, leave them in the drop-box outside Village Hall, or fax them to Finance.
Frequently asked questions
- What does the Automatic Utility Pay Agreement authorize?
- It authorizes the Village of Lincolnshire and the designated financial institution to make automatic deductions for water and sewer bills on each bill’s due date.
- What should I include with the agreement?
- Include a voided check for the account to be debited. If you use a savings account, include the deposit slip instead.
- How do I submit the Automatic Utility Pay Agreement?
- Return the signed agreement and voided check to the Village at 1 Olde Half Day Road, leave them in the drop-box outside Village Hall, or fax them to 847-883-8608, Attn: Finance.
- Do I need a notary for the Automatic Utility Pay Agreement?
- No. Sign and date the agreement without a notary. Attach a voided check, or a deposit slip if using savings; the document does not mention a notarized attachment.
Need something notarized?
This Automatic Utility Pay Agreement doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.