Hilton, NY · Monroe County
Automatic Bank Deduction Form
Water utility customers use this form to authorize the Village of Hilton to deduct their bill automatically from a bank account.
What this form is
This form lets a water utility customer authorize automatic deductions from the bank account connected to an enclosed voided check or deposit slip. The Village says deductions begin with the next bill and occur on the day indicated on the bill. The form requests the customer’s name, service address, phone number, effective date, signature, and date.
Who needs it
Water utility customers who want the Village of Hilton to deduct their bills automatically from a bank account should complete this form.
How to submit it
Mail the signed form with a voided check for the account to be charged to the Village of Hilton, 59 Henry Street, Hilton, NY 14468.
About notarization
This form is signed and dated without a notary; the only attachment requested is a voided check or deposit slip, not a notarized document.
How to submit this form
- 1
Download the Form
Download the Village of Hilton Automatic Bank Deduction Form.
- 2
Complete the Form
Fill in the customer name, service address, phone number, and effective date.
- 3
Sign and Date
Add the resident authorization signature and date.
- 4
Gather the Attachment
Include a voided check or deposit slip for the bank account to be charged.
- 5
Mail to the Village
Mail the form and attachment to the Village of Hilton at 59 Henry Street, Hilton, NY 14468.
Frequently asked questions
- Do I need a notary for the Automatic Bank Deduction Form?
- No. Sign and date the form without a notary. Include a voided check or deposit slip for the account you want charged.
- How do I submit the Automatic Bank Deduction Form?
- Mail the signed form and a voided check to the Village of Hilton, 59 Henry Street, Hilton, NY 14468.
- When do automatic deductions begin?
- The form says deductions begin with your next bill and are made on the day indicated on that bill.
- What information does the form request?
- It requests the customer name as it appears on the water bill, service address, phone number, effective date, resident authorization signature, and date.