New Berlin, IL · Sangamon County
Authorization Agreement for ACH Debits
Village customers use this agreement to authorize monthly automatic bank withdrawals for water, sewer, or internet bill payments.
What this form is
Village customers complete this agreement to authorize monthly automatic bank drafts for water, sewer, and internet bills. It requests the service address, bank name and city, routing and account numbers, account type, name, signature, and date; include a void check or personalized deposit slip. The form says withdrawals occur on or about the 20th of each month and continue until the Village receives written termination notice.
Who needs it
Village customers who want to pay water, sewer, or internet bills by monthly automatic bank draft should complete this agreement.
How to submit it
Return the completed agreement with a void check or personalized deposit slip to the Village of New Berlin Water Department, PO Box 357, New Berlin, IL 62670.
About notarization
This agreement is signed and dated without a notary; the form asks for no sworn or notarized attachment.
How to submit this form
- 1
Download The Agreement
Download the Authorization Agreement for ACH Debits.
- 2
Complete The Form
Enter your service address and bank details, select checking or savings, then print your name and sign and date the agreement.
- 3
Gather The Attachment
Attach a void check or personalized deposit slip.
- 4
Return It To The Village
Send the agreement and attachment to the Village of New Berlin Water Department at PO Box 357, New Berlin, IL 62670.
Frequently asked questions
- Do I need a notary for this ACH agreement?
- No. Sign and date the agreement; it does not request a sworn or notarized attachment.
- How do I submit the ACH debit agreement?
- Return it to the Village of New Berlin Water Department, PO Box 357, New Berlin, IL 62670, with a void check or personalized deposit slip.
- Which bills can be paid by automatic bank draft?
- The agreement authorizes monthly automatic bank drafts for water, sewer, and internet payments to the Village.
- What information does the agreement request?
- It asks for your service address, bank name and city, routing and account numbers, account type, name, signature, and date.