New Knoxville, OH · Auglaize County
Utilities Direct Payment Authorization Form
New Knoxville utility customers use this form to authorize monthly payments of the full amount shown on their utility statement from a checking or savings account.
What this form is
This form authorizes the Village of New Knoxville to initiate monthly payments for the full amount shown on the customer's utility statement and make adjustments for transactions credited in error. It asks for the customer's printed name and address, financial institution name and address, routing number, account type and number, signature, and date. The form does not state when direct payment is required.
Who needs it
A utility customer who wants to authorize monthly payments from a checking or savings account can complete and sign 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; it lists no notarized or sworn attachment or related step.
How to submit this form
- 1
Download The Form
Download the Utilities Direct Payment Authorization Form.
- 2
Complete Your Information
Print your name and address, then provide your financial institution's name and address, routing number, and account type and number.
- 3
Sign And Date
Sign and date the authorization.
- 4
Submit To The City
Submit the form to the city department named on it; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Utilities Direct Payment Authorization Form?
- No. The form asks for a signature and date, but no notary or notarized attachment is listed.
- What does this form authorize?
- It authorizes the Village of New Knoxville to initiate monthly entries for the full amount shown on your utility statement and adjust transactions credited in error.
- What information does the form ask for?
- It asks for your printed name and address, financial institution name and address, routing number, checking or savings account number, signature, and date.
- How do I submit the Utilities Direct Payment Authorization Form?
- 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.