Laurel, MT · Yellowstone County
ACH Debit Authorization Form
This form lets a Laurel account holder authorize the City of Laurel to debit a checking or savings account through direct ACH payments.
What this form is
The form authorizes the City of Laurel to initiate ACH debit entries from the account selected by the signer. It asks for the depository name and branch, account type, routing and account numbers, contact information, printed name, signature, and date. The authorization remains in effect until the city receives written notice of termination; attach a voided check if a checking account will be debited.
Who needs it
A person authorizing the City of Laurel to debit their checking or savings account for direct payments should complete 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 form is signed and dated without a notary; attach a voided check if a checking account will be debited.
How to submit this form
- 1
Download The Form
Download the ACH Debit Authorization Form.
- 2
Complete The Form
Select checking or savings and fill in the requested depository, account, and contact details.
- 3
Gather The Attachment
Attach a voided check if a checking account will be debited.
- 4
Sign And Submit
Sign and date the form, then submit it to the city department named on the form.
Frequently asked questions
- What does the ACH Debit Authorization Form do?
- It authorizes the City of Laurel to initiate ACH debit entries from the checking or savings account selected on the form.
- What information does the form ask for?
- It asks for account type, depository and account details, contact information, the signer’s printed name, signature, and date.
- Do I need a notary for the ACH Debit Authorization Form?
- No. The form is signed and dated without a notary. Attach a voided check if a checking account will be debited.
- How do I submit the ACH Debit Authorization Form?
- Submit it to the city department named on the form; check the city website for current contact details.