Louisville, NY · St. Lawrence County
Direct Debit Plan (ACH) Enrollment Form
This form lets Town of Louisville water customers authorize quarterly automatic water bill payments from a checking account.
What this form is
Water customers use this form to authorize the Town of Louisville to deduct regular bill payments from a checking account. Payments are withdrawn quarterly, and customers continue to receive a quarterly bill. The form requests account and contact details, a signature, and a blank voided check; customers may withdraw their consent by contacting the Town.
Who needs it
Town of Louisville water customers who want regular water bill payments withdrawn automatically from a checking account should submit this form.
How to submit it
Submit the completed form with a blank voided check to the Town of Louisville at 14810 State Highway 37 in person, by mail, or via the payment drop box. You may also email it to [email protected].
About notarization
This document is signed without a notary; include a blank voided check, and the signer just signs and dates the form.
How to submit this form
- 1
Download the Form
Download the Direct Debit Plan (ACH) Enrollment Form.
- 2
Complete the Form
Print clearly and provide the requested account, address, and contact information; then sign and date the form.
- 3
Gather the Attachment
Include a blank voided check with the completed form; a copy is acceptable.
- 4
Submit to the Town
Submit in person, by mail, or via the payment drop box at 14810 State Highway 37, or email [email protected].
Frequently asked questions
- Do I need a notary for the Direct Debit Plan (ACH) Enrollment Form?
- No. This form is signed without a notary. Include a blank voided check with your completed form.
- How do I submit the Direct Debit Plan (ACH) Enrollment Form?
- Submit it in person, by mail, or via the payment drop box at 14810 State Highway 37, or email it to [email protected]. Include a blank voided check.
- When are ACH payments withdrawn?
- The form says payments are withdrawn quarterly, approximately January 20, April 20, July 20, and September 20.
- What information does the enrollment form request?
- It asks for the water account number, account name, service and mailing addresses, email address, phone number, date, and signature. Include a blank voided check.
Need something notarized?
This Direct Debit Plan (ACH) Enrollment Form doesn’t need a notary — but if you have another Louisville form that does, a commissioned online notary can help.