Do I need a notary for the ACH Debit Authorization Agreement?

No. The form calls for signatures and a date, not a notary. Attach a copy of a voided check; the form does not say it must be notarized or sworn.

How do I submit the ACH Debit Authorization Agreement?

The form lists City Offices at 100 West Fourth Street, Waterloo, Illinois 62298, but does not specify how to submit it. Contact the city using the phone number printed on the form.

What information does the agreement request?

It asks for financial institution details, routing and account numbers, account type, customer names and contact details, signatures, date, and utility account number.

What attachment does the form request?

The form says to attach a copy of a voided check.

Waterloo, IL · Monroe County

No notary required

ACH Debit Authorization Agreement

Waterloo utility customers use this agreement to authorize the city to debit monthly payments from a specified checking or savings account.

What this form is

This agreement authorizes the City of Waterloo to debit payments from the financial institution account identified on the form. The form asks for the institution and branch address, routing and account numbers, account type, customer details, signatures, date, and utility account number. It says the account will be debited on or around the fifth of the month and requests a copy of a voided check.

Who needs it

Waterloo utility customers who want to authorize direct payments from a checking or savings account should complete this agreement.

How to submit it

The form lists City Offices at 100 West Fourth Street, Waterloo, Illinois 62298, and phone number (618) 939-8600. It does not give a submission method.

About notarization

This document is signed and dated without a notary; attach a copy of a voided check, and the form does not say that attachment must be notarized or sworn.

How to submit this form

1
Download the Agreement
Download the ACH Debit Authorization Agreement PDF.
2
Complete the Account Details
Enter the financial institution information, routing and account numbers, account type, customer details, and utility account number.
3
Sign and Attach a Check Copy
Provide the requested signatures and date, and attach a copy of a voided check.
4
Submit to the City
The form lists City Offices at 100 West Fourth Street, Waterloo, Illinois 62298; it does not specify a submission method.

Frequently asked questions

Do I need a notary for the ACH Debit Authorization Agreement?: No. The form calls for signatures and a date, not a notary. Attach a copy of a voided check; the form does not say it must be notarized or sworn.
How do I submit the ACH Debit Authorization Agreement?: The form lists City Offices at 100 West Fourth Street, Waterloo, Illinois 62298, but does not specify how to submit it. Contact the city using the phone number printed on the form.
What information does the agreement request?: It asks for financial institution details, routing and account numbers, account type, customer names and contact details, signatures, date, and utility account number.
What attachment does the form request?: The form says to attach a copy of a voided check.

Need something notarized?

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