Gaines, NY · Orleans County
ACH Recurring Payment Authorization Form
Gaines water customers use this form to authorize recurring quarterly water bill payments from a checking or savings account.
What this form is
This form authorizes the Town of Gaines to debit a customer’s checking or savings account for water bills on each quarterly billing due date. It asks for the customer’s contact details, account type, bank and account information, and signature and date. The authorization remains in effect until canceled in writing, and the form says account changes or termination must be reported in writing at least 15 days before the next billing date.
Who needs it
Town of Gaines water customers who want their quarterly water bill automatically deducted from a checking or savings 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 document is signed and dated without a notary; the signer just signs and dates the authorization.
How to submit this form
- 1
Download The Form
Download the ACH Recurring Payment Authorization Form.
- 2
Complete The Form
Enter your contact details, account type, name on the account, and bank and account information.
- 3
Sign And Date
Sign and date the authorization to permit recurring quarterly water bill debits.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the ACH Recurring Payment Authorization Form do?
- It authorizes the Town of Gaines to debit a checking or savings account for a water bill on each quarterly billing due date.
- Who should complete this form?
- A Town of Gaines water customer who wants recurring water bill payments deducted from a checking or savings account should complete and sign it.
- Do I need a notary for the ACH Recurring Payment Authorization Form?
- No. The document calls for the customer to sign and date the authorization; it does not require a notary.
- How do I submit the ACH Recurring Payment Authorization Form?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This ACH Recurring Payment Authorization Form doesn’t need a notary — but if you have another Gaines form that does, a commissioned online notary can help.