Lena, IL · Stephenson County
ACH Form for Water Bill
This form lets Village of Lena water customers authorize electronic debits from a designated bank account for their water bill.
What this form is
Use this form to authorize the Village of Lena to electronically debit the account listed for water bill payments and to make credits or corrective debits when needed. It asks for account and depository information, the debit amount and frequency, and an entry start date. The signer authorizes the transactions and agrees to give at least seven days’ notice to cancel.
Who needs it
A Village of Lena water customer who wants to authorize ACH payments from a checking, savings, loan, or other listed account needs this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the signer just signs and dates the authorization.
How to submit this form
- 1
Download The Form
Download the ACH Form for Water Bill PDF.
- 2
Complete The Authorization
Enter the account, depository, debit amount, frequency, and start-date information, and select the applicable options.
- 3
Sign And Date
The account holder signs and dates the authorization.
- 4
Submit To The City
Submit the completed form to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the ACH Form for Water Bill authorize?
- It authorizes the Village of Lena to electronically debit the account provided for water bill payments and to make credits or corrective debits when necessary.
- What information does the form ask for?
- It asks for company and depository account details, account type, account holder names, consumer-account status, debit amount and frequency, and an entry start date.
- Do I need a notary for the ACH Form for Water Bill?
- No. This document is signed without a notary; the signer just signs and dates the authorization.
- How do I submit the ACH Form for Water Bill?
- Submit it to the city department named on the form; check the city website for current contact details.