Mendota, IL · LaSalle County
Authorization Agreement for Pre-Authorized Payments (Debits)
This form lets a customer authorize the City of Mendota to debit a bank account for loan payments and make adjustments for debit errors.
What this form is
Customers use this agreement to authorize the City of Mendota to debit their account for loan payments and, if needed, make credit adjustments for debit entries made in error. It asks for company and tax identification details, customer and bank account information, and a signature. The form requests an attached voided check and says the authorization remains in effect until written termination notice is received or the loan is paid in full.
Who needs it
A customer who wants to authorize the City of Mendota to debit an account for loan payments should complete this agreement.
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; attach a voided check, and the signer signs and dates the agreement.
How to submit this form
- 1
Download The Agreement
Download the City of Mendota Authorization Agreement for Pre-Authorized Payments (Debits).
- 2
Complete The Form
Enter the company, customer, and depository institution details requested, then date and sign the agreement.
- 3
Attach A Voided Check
Attach a voided check as requested by the form.
- 4
Submit To The City
Submit the completed agreement to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the pre-authorized payment agreement authorize?
- It authorizes the City of Mendota to debit the customer's account for loan payments and, if necessary, make credit adjustments for debit entries made in error.
- What information and attachment does the form ask for?
- The form asks for company and tax identification details, customer and bank account information, and a signature. It also requests an attached voided check.
- Do I need a notary for this pre-authorized payment agreement?
- No. This document is signed without a notary; attach a voided check, and the signer signs and dates the agreement.
- How do I submit the pre-authorized payment agreement?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Authorization Agreement for Pre-Authorized Payments (Debits) doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.