Do I need a notary for the Direct Debit ACH Authorization Agreement?

No. The agreement has no notary requirement; the account holder signs and dates it, and the form asks for a voided check for verification.

How do I submit the Direct Debit ACH agreement?

Submit it to the Village Clerk’s office or email it to Clerk@PalmyraVillageNY.org. The form says to allow 20 days for account setup.

What information does the agreement ask for?

It asks for your water and sewer account number, account name, service address, email address, financial institution, checking account name, routing number, and account number.

What does the direct debit service cover?

The Village’s free service electronically withdraws water and sewer payments from your checking account on the bill due date.

Palmyra, NY · Wayne County

No notary required

Direct Debit (ACH) Withdrawal Authorization Agreement Form

Village of Palmyra utility customers use this agreement to authorize automatic water and sewer bill payments from a checking account.

What this form is

This agreement enrolls a Village of Palmyra customer in the free utility direct debit service, which withdraws water and sewer payments from a checking account on the bill due date. It asks for water and sewer account details, service address, email, bank information, and the account holder’s signature. The form also offers options for email billing and includes a request to attach a voided check for verification.

Who needs it

Village of Palmyra water and sewer customers who want payments withdrawn automatically from a checking account should complete this agreement.

How to submit it

Submit the completed form to the Village Clerk’s office or email it to [email protected]. The form asks customers to allow 20 days for account setup.

About notarization

This document is signed and dated without a notary; the signer also checks a box indicating that a voided check is attached for verification.

How to submit this form

1
Download the Agreement
Download the Village of Palmyra Direct Debit (ACH) Withdrawal Authorization Agreement Form.
2
Complete the Form
Provide your water and sewer account details, contact information, and checking account information.
3
Gather the Attachment
Attach a voided check for verification, as indicated on the form.
4
Sign and Submit
Sign and date the agreement, then submit it to the Village Clerk’s office or email it to [email protected].

Frequently asked questions

Do I need a notary for the Direct Debit ACH Authorization Agreement?: No. The agreement has no notary requirement; the account holder signs and dates it, and the form asks for a voided check for verification.
How do I submit the Direct Debit ACH agreement?: Submit it to the Village Clerk’s office or email it to [email protected]. The form says to allow 20 days for account setup.
What information does the agreement ask for?: It asks for your water and sewer account number, account name, service address, email address, financial institution, checking account name, routing number, and account number.
What does the direct debit service cover?: The Village’s free service electronically withdraws water and sewer payments from your checking account on the bill due date.

Need something notarized?

This Direct Debit (ACH) Withdrawal Authorization Agreement Form doesn’t need a notary — but if you have another Palmyra form that does, a commissioned online notary can help.