Lakewood, IL · McHenry County
Utility Billing Automatic Payment Authorization
Lakewood utility customers use this form to authorize automatic bank debits for their utility bill and provide the account details needed for enrollment.
What this form is
This form authorizes the Village of Lakewood to debit a designated checking or savings account for utility payments. Customers enrolling in the automatic payment program provide financial institution and account details, sign and date the authorization, and attach a voided check; investment and money market accounts are not accepted. The completed form must be received before the first day of the desired billing month.
Who needs it
Lakewood utility customers who want the Village to automatically debit their eligible bank account for utility payments need this form.
How to submit it
Submit the completed form and attached voided check to the Village of Lakewood at 2500 Lake Avenue, Village of Lakewood 60014. The form says deposit slips will not be accepted.
About notarization
This document is signed without a notary; the signer signs and dates the authorization and attaches a voided check.
How to submit this form
- 1
Download The Form
Download the Utility Billing Automatic Payment Authorization PDF.
- 2
Complete The Authorization
Enter your financial institution and account details, then sign and date the form.
- 3
Attach A Voided Check
Attach a voided copy of your check. Deposit slips will not be accepted.
- 4
Submit To The Village
Submit the completed form and voided check to the Village address shown on the form before the first day of the desired billing month.
Frequently asked questions
- Do I need a notary for the Utility Billing ACH Authorization?
- No. The signer signs and dates the authorization without a notary and attaches a voided check.
- How do I submit the Utility Billing ACH Authorization?
- Submit the completed form with a voided check to the Village of Lakewood at 2500 Lake Avenue, Village of Lakewood 60014. Deposit slips are not accepted.
- What must I attach to the authorization form?
- Attach a voided copy of your check. The form states that deposit slips will not be accepted.
- Which accounts are eligible for automatic payments?
- The form allows checking or savings accounts. Investment and money market accounts are not eligible for the program.
Need something notarized?
This Utility Billing Automatic Payment Authorization doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.