Do I need a notary for the Utility Billing Direct Debit Authorization?

No. Sign and date the form without a notary, and attach a voided check for account verification.

How do I submit the direct debit authorization?

Submit the signed form and a voided check to the City Clerk’s Office in person, by mail, or in the drop box outside City Hall. The listed mailing address is P.O. Box 467, Columbia, IL 62236.

What information does the form ask for?

It asks for your utility account number, name, address, contact phone number, financial institution, branch, account number, routing number, signature, and date.

What kind of bank account can be used?

The account to be debited must be a checking account, and the person signing the form must be named on that account.

Columbia, IL · Monroe County

No notary required

Authorization for Utility Billing Direct Debit

Columbia utility customers use this form to authorize automatic monthly withdrawals from a checking account for their utility bill.

What this form is

This form authorizes the City of Columbia to debit a checking account for the exact amount of the customer’s monthly utility bill. The form asks for the utility account holder’s contact details and bank account information, along with a signature and date. To start the service, submit the signed form with a voided check attached; the person signing must be named on the checking account.

Who needs it

A Columbia utility customer who wants monthly bills automatically withdrawn from a checking account should complete and submit this authorization.

How to submit it

Submit the signed form with a voided check to the City Clerk’s Office at City Hall in person, by mail, or in the drop box outside City Hall. The form lists City of Columbia, Attn: City Clerk’s Office, P.O. Box 467, Columbia, IL 62236.

About notarization

This form is signed and dated without a notary; the required attachment is a voided check, not a notarized or sworn document.

How to submit this form

1
Download The Form
Download the Utility Billing Direct Debit Authorization form.
2
Complete The Form
Provide your utility account and contact details, checking account information, signature, and date.
3
Attach A Voided Check
Attach a voided check for account verification; do not attach a deposit slip.
4
Submit To The City
Deliver it to the City Clerk’s Office in person, by mail, or in the drop box outside City Hall.

Frequently asked questions

Do I need a notary for the Utility Billing Direct Debit Authorization?: No. Sign and date the form without a notary, and attach a voided check for account verification.
How do I submit the direct debit authorization?: Submit the signed form and a voided check to the City Clerk’s Office in person, by mail, or in the drop box outside City Hall. The listed mailing address is P.O. Box 467, Columbia, IL 62236.
What information does the form ask for?: It asks for your utility account number, name, address, contact phone number, financial institution, branch, account number, routing number, signature, and date.
What kind of bank account can be used?: The account to be debited must be a checking account, and the person signing the form must be named on that account.

Need something notarized?

This Authorization for Utility Billing Direct Debit doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.