What does the Cullom ACH Authorization Agreement authorize?

It authorizes the Village of Cullom to debit the previous month’s water and garbage service balance from the checking or savings account you select.

What information does the ACH agreement ask for?

It asks for the depository name and branch, city, state, ZIP code, routing number, account number, account type, account holder name, date, and signature.

Do I need a notary for the ACH Authorization Agreement?

No. Sign and date the agreement; it does not mention any notarized or sworn attachment or related step.

Cullom, IL · Livingston County

No notary required

ACH Authorization Agreement

Cullom residents can use this agreement to authorize monthly ACH debits from a checking or savings account for water and garbage service balances.

What this form is

This agreement authorizes the Village of Cullom to debit the previous month’s balance for water and garbage services from the account you select. It asks for the depository’s name and branch, location, routing and account numbers, account type, and the account holder’s name, date, and signature. The authorization continues until the Village receives written notice to end it.

Who needs it

Cullom residents who want to pay their water and garbage service balances through monthly automatic debits can 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 agreement is signed and dated without a notary; it does not mention any notarized or sworn attachment or related step.

How to submit this form

1
Download The Agreement
Download the Cullom ACH Authorization Agreement PDF.
2
Complete The Agreement
Select checking or savings and enter the requested account holder and depository information.
3
Review And Sign
Check the information, then provide the account holder’s name, date, and signature.
4
Submit To The Village
Submit it to the city department named on the form; check the city website for current contact details.

Frequently asked questions

What does the Cullom ACH Authorization Agreement authorize?: It authorizes the Village of Cullom to debit the previous month’s water and garbage service balance from the checking or savings account you select.
What information does the ACH agreement ask for?: It asks for the depository name and branch, city, state, ZIP code, routing number, account number, account type, account holder name, date, and signature.
Do I need a notary for the ACH Authorization Agreement?: No. Sign and date the agreement; it does not mention any notarized or sworn attachment or related step.
How do I submit the ACH Authorization Agreement?: Submit it to the city department named on the form; check the city website for current contact details.

Need something notarized?

This ACH Authorization Agreement doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.