Rush Notary

Angier, NC · Harnett County

No notary required

Customer Payment Request Form

This form lets someone request a payment to a Town of Angier utility account belonging to another customer or to a random account.

What this form is

Use this form to make a payment on a utility account for someone other than yourself. It asks for the request date, payment amount, customer name and address, and account number, with options to pay a random account or keep the payment anonymous. The form also includes the payer’s name and signature fields.

Who needs it

Anyone making a payment to a Town of Angier utility account belonging to another person can complete this form.

How to submit it

Make checks payable to the Town of Angier, using the payee address shown on the form: 55 N Broad Street W, Angier, NC 27501.

About notarization

This document is signed without a notary; the signer just signs and dates the form.

How to submit this form

  1. 1

    Download The Form

    Download the Customer Payment Request Form PDF.

  2. 2

    Complete The Form

    Enter the date, payment amount, customer and account details, and payer information; select the applicable account and anonymity options.

  3. 3

    Sign And Date

    Sign and date the form.

  4. 4

    Prepare Payment

    Make the check payable to the Town of Angier using the payee address shown on the form.

Frequently asked questions

Do I need a notary for the Customer Payment Request Form?
No. This form is signed without a notary; the signer just signs and dates it.
Who can use the Customer Payment Request Form?
Anyone making a payment on a Town of Angier utility account for someone other than themselves can use the form.
What information does the form ask for?
It asks for the date, payment amount, customer name and address, account number, and payer information. It also offers options for a random account or an anonymous payment.
How do I submit the Customer Payment Request Form?
Make checks payable to the Town of Angier and use the payee address shown on the form: 55 N Broad Street W, Angier, NC 27501.

Need something notarized?

This Customer Payment Request Form doesn’t need a notary — but if you have another Angier form that does, a commissioned online notary can help.