Lowell, NC · Gaston County
ACH Authorization Form
Lowell utility customers use this form to authorize automatic monthly payments from a checking or savings account.
What this form is
This form authorizes the City of Lowell to debit a checking or savings account for utility payments and make necessary corrections. It asks for financial institution and account details, the customer’s name and contact information, utility account number, signature, and date. The form states that draft amounts vary with water use or rate changes and instructs customers to attach a voided check.
Who needs it
Lowell utility customers who want monthly utility payments drafted from a checking or savings account should complete this authorization.
How to submit it
The form does not provide submission instructions. 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 as instructed.
How to submit this form
- 1
Download The Form
Download the ACH Authorization Form PDF.
- 2
Complete The Form
Enter your financial institution and account details, contact information, utility account number, signature, and date.
- 3
Attach A Voided Check
Attach a voided check as instructed on the form.
- 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
- Do I need a notary for the ACH Authorization Form?
- No. Sign and date the form without a notary, and attach a voided check as instructed.
- How do I submit the ACH Authorization Form?
- The form does not provide submission instructions. Submit it to the city department named on the form and check the city website for current contact details.
- What should I attach to the form?
- The form instructs you to attach a voided check.
- When does Lowell draft utility payments?
- The form states that accounts are drafted between the 12th and 17th of every month.