Pecatonica, IL · Winnebago County
Authorization for Automatic Withdrawal
Pecatonica customers use this form to authorize automatic bank withdrawals for water, sewer, and recycle payments.
What this form is
This form authorizes the Village of Pecatonica to deduct water, sewer, and recycle payments from a customer's bank account by electronic fund transfer. It asks for customer and financial institution details, the account type, and an authorized signature and date. The form lists the transaction date as the 25th of each month and requests a voided check and/or savings deposit slip.
Who needs it
Pecatonica customers who want to pay water, sewer, and recycle charges by automatic withdrawal from a bank account need 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 authorization is signed and dated without a notary; attach a voided check and/or savings deposit slip, with no sworn or notarized attachment stated.
How to submit this form
- 1
Download the Form
Download the automatic withdrawal authorization form.
- 2
Complete the Form
Provide the requested customer and financial institution information, select checking or savings, then sign and date.
- 3
Gather the Attachment
Attach a copy of a voided check and/or savings deposit slip.
- 4
Submit to the Village
Submit the completed form and attachment to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the automatic withdrawal form authorize?
- It authorizes the Village of Pecatonica to deduct water, sewer, and recycle payments from the customer's bank account by electronic fund transfer.
- What information and attachments does the form request?
- It requests customer and bank details, account type, and an authorized signature and date. Attach a copy of a voided check and/or savings deposit slip.
- Do I need a notary for the automatic withdrawal authorization?
- No. Sign and date the authorization without a notary. Attach a voided check and/or savings deposit slip; the form does not state that any attachment must be notarized or sworn.
- How do I submit the automatic withdrawal authorization?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Authorization for Automatic Withdrawal doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.