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

No. The form has a signature and date line, but no notary block. It asks you to attach a copy of a check from the checking or savings account.

What attachment does the form require?

The form requests a copy of a check from your checking or savings account to be attached to the completed agreement.

How do I submit the Direct Debit Authorization Agreement?

Submit the completed form and attached check copy to Village Hall at 101 S. Main Street, Smithton, IL 62285, or drop it by the office.

Smithton, IL · St. Clair County

No notary required

Direct Debit Authorization Agreement

Smithton utility customers use this agreement to authorize the Village to withdraw payment for utility services from a checking or savings account.

What this form is

This agreement authorizes the Village of Smithton to withdraw payment for utility services from the account listed on the form. The signer provides their name, account address, phone number, bank name, account number, and routing number. The form also requests a copy of a check from the checking or savings account.

Who needs it

A utility customer who wants to authorize the Village of Smithton to withdraw payments from a checking or savings account should complete this agreement.

How to submit it

Submit the completed form and a copy of a checking or savings account check to Village Hall, 101 S. Main Street, Smithton, IL 62285, or drop it by the office.

About notarization

This agreement is signed and dated without a notary; attach a copy of a check from the checking or savings account, as the form requests.

How to submit this form

1
Download The Agreement
Download the Direct Debit Authorization Agreement PDF.
2
Complete The Form
Enter your name, account address, phone number, bank name, account number, and routing number; then sign and date the form.
3
Attach A Check Copy
Attach a copy of a check from the checking or savings account listed on the form.
4
Submit To The Village
Submit the form and check copy to Village Hall, 101 S. Main Street, Smithton, IL 62285, or drop them by the office.

Frequently asked questions

Do I need a notary for the Direct Debit Authorization Agreement?: No. The form has a signature and date line, but no notary block. It asks you to attach a copy of a check from the checking or savings account.
What information does the agreement request?: It asks for your name, account address, phone number, bank name, account number, and routing number, along with your signature and date.
What attachment does the form require?: The form requests a copy of a check from your checking or savings account to be attached to the completed agreement.
How do I submit the Direct Debit Authorization Agreement?: Submit the completed form and attached check copy to Village Hall at 101 S. Main Street, Smithton, IL 62285, or drop it by the office.

Need something notarized?

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