Flanagan, IL · Livingston County
Consumer Authorization for Direct Payment Via ACH (ACH Debits)
This form lets a Flanagan consumer authorize the Village to debit a checking or savings account for payments by ACH.
What this form is
Use this form to authorize the Village of Flanagan to electronically debit a consumer checking or savings account, and, if necessary, credit the account to correct erroneous debits. It asks for bank and account details, the debit amount or method for determining it, debit dates or frequency, and the consumer’s printed name, signature, and date. It also includes an option to receive paperless billing and describes how to revoke authorization.
Who needs it
A consumer who wants to authorize the Village of Flanagan to collect payments by ACH debit from a checking or savings account needs 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 and dated without a notary; it does not mention any attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download The Form
Download the Consumer Authorization for Direct Payment Via ACH form.
- 2
Complete The Form
Select checking or savings, provide the requested bank and account details, and enter the debit amount or method and debit dates or frequency.
- 3
Sign And Date
Print your name, sign the form, and enter the date.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the ACH debit authorization form do?
- It authorizes the Village of Flanagan to electronically debit a consumer’s checking or savings account for payments, and, if necessary, credit the account to correct erroneous debits.
- What information does the form ask for?
- It asks for the depository bank name, routing and account numbers, email, debit amount or method, debit dates or frequency, and the consumer’s printed name, signature, and date.
- Do I need a notary for the ACH debit authorization form?
- No. The document is signed and dated without a notary, and it does not mention any attachment or related step that must be notarized or sworn.
- How do I submit the ACH debit authorization form?
- Submit it to the city department named on the form; check the city website for current contact details.