Loami, IL · Sangamon County
Automatic Payment Authorization Form
Village of Loami water and sewer customers use this form to authorize monthly automatic bank withdrawals for their bills.
What this form is
This form lets a Village of Loami customer authorize monthly ACH withdrawals for water and sewer bills. It is for customers who choose the automatic payment option. The form asks for the account number, service address, bank and account details, account type, name, signature, and date; it also requests a voided check or personalized deposit slip.
Who needs it
A Village of Loami water or sewer customer who wants to pay monthly bills by automatic bank draft should complete this form.
How to submit it
Complete the form, attach a voided check or personalized deposit slip, and return it to the Village of Loami at 602 N. Main Street, P.O. Box 226, Loami, IL 62661.
About notarization
This document is signed and dated without a notary; it requests a voided check or personalized deposit slip, with no sworn or notarized attachment mentioned.
How to submit this form
- 1
Download the Form
Download the Automatic Payment Authorization Form for Village of Loami water and sewer bills.
- 2
Complete the Form
Enter your account, service address, bank, account type, and contact details, then sign and date the authorization.
- 3
Gather the Attachment
Attach a voided check or personalized deposit slip as requested by the form.
- 4
Submit to the Village
Return the completed form and attachment to the Village of Loami, 602 N. Main Street, P.O. Box 226, Loami, IL 62661.
Frequently asked questions
- Do I need a notary for the Automatic Payment Authorization Form?
- No. The form requires a signature and date, not notarization. Attach a voided check or personalized deposit slip; the document does not say either attachment must be notarized.
- How do I submit the Automatic Payment Authorization Form?
- Complete and sign the form, attach a voided check or personalized deposit slip, and return it to the Village of Loami at 602 N. Main Street, P.O. Box 226, Loami, IL 62661.
- What information does the form ask for?
- It asks for your water/sewer account number, service address, bank name, routing and account numbers, account type, printed name, signature, and date.
- When are automatic payments withdrawn?
- The form says payments are made monthly by automatic bank draft, with withdrawals occurring on or about the 15th of each month for the exact monthly water and sewer bill.