Jerome, IL · Sangamon County
Direct Debit Sign Up Form
Jerome residents use this form to provide utility account and bank details and authorize direct debit from a checking or savings account.
What this form is
The Direct Debit Sign Up Form collects a resident’s contact information, utility account number, bank details, and authorized signature to sign up for direct debit. The form is for utility account holders who want to provide payment account information to the Village of Jerome. It asks for the bank routing and account numbers and whether the account is checking or savings.
Who needs it
Jerome utility account holders who want to sign up for direct debit and authorize use of a checking or savings account need this form.
How to submit it
The form lists the Village of Jerome at 2901 Leonard Street, Springfield, IL 62704, and phone number 217-546-2203. Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This form is signed without a notary; the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the Direct Debit Sign Up Form PDF.
- 2
Complete The Form
Enter your contact information, utility account number, bank details, and checking or savings account type.
- 3
Sign And Date
Provide the authorized signature on the account and enter the date.
- 4
Submit To The Village
Use the Village of Jerome address listed on the form and check the city website for current contact details.
Frequently asked questions
- What information does the Direct Debit Sign Up Form ask for?
- It asks for contact information, a utility account number, bank name and contact details, routing and account numbers, account type, and an authorized signature.
- Do I need a notary for the Direct Debit Sign Up Form?
- No. This form is signed and dated without a notary; it does not list any notarized or sworn attachment.
- How do I submit the Direct Debit Sign Up Form?
- The form lists the Village of Jerome address at 2901 Leonard Street, Springfield, IL 62704. Check the city website for current contact details.