Do I need a notary for the Credit/Debit Authorization Form?

No. This form is signed and dated without a notary, and it lists no notarized or sworn attachment.

What information does the form ask for?

It asks for financial institution and account details, account type, the water book account number, a phone number, and the signer’s signature and date.

When will monthly payments begin?

The form says that if the Clerk receives it before the 25th of the month, payments begin on the first of the next month.

Mansfield, IL · Piatt County

No notary required

Credit/Debit Authorization Form

Mansfield water customers use this form to authorize monthly payments from a checking or savings account.

What this form is

This form authorizes the Village of Mansfield to make a $42.00 monthly debit from a checking or savings account and correct transactions credited or debited in error. It requests financial institution and account details, the water book account number, a phone number, and the signer’s signature and date. The form says to return it before the 25th for payments to begin on the first of the next month.

Who needs it

Mansfield water customers who want to authorize monthly $42.00 payments from a checking or savings account need this form.

How to submit it

Return the form to the Village water payment drop box at 101 E. State St. or mail it to PO Box 10, Mansfield, IL 61854. The form says the Clerk must receive it before the 25th for payments to begin the following month.

About notarization

This form is signed and dated without a notary; it lists no notarized or sworn attachment, so the signer just signs and dates it.

How to submit this form

1
Download The Form
Download the Credit/Debit Authorization Form for Mansfield.
2
Complete The Form
Enter the financial institution and account details, water book account number, phone number, and desired starting month.
3
Sign And Date
Sign and date the authorization form.
4
Return It To The Village
Use the Village water payment drop box at 101 E. State St. or mail it to PO Box 10, Mansfield, IL 61854.

Frequently asked questions

Do I need a notary for the Credit/Debit Authorization Form?: No. This form is signed and dated without a notary, and it lists no notarized or sworn attachment.
How do I submit the Credit/Debit Authorization Form?: Return it to the Village water payment drop box at 101 E. State St. or mail it to PO Box 10, Mansfield, IL 61854.
What information does the form ask for?: It asks for financial institution and account details, account type, the water book account number, a phone number, and the signer’s signature and date.
When will monthly payments begin?: The form says that if the Clerk receives it before the 25th of the month, payments begin on the first of the next month.

Need something notarized?

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