Ashley, OH · Delaware County
Authorization Agreement for Preauthorized Payments
This agreement lets a Village of Ashley utility customer authorize recurring debit payments from a specified financial institution account.
What this form is
The agreement authorizes the Village of Ashley to debit a customer’s checking or savings account for utility payments. It asks for financial institution and account details, payment start and end dates, a debit date, service address, account number, printed name, and signature. The form also asks the customer to attach a copy of a voided check.
Who needs it
A Village of Ashley utility customer who wants to authorize preauthorized payments from a checking or savings account needs this agreement.
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 agreement is signed without a notary; it requests a copy of a voided check, and the signer completes the payment dates and signs it.
How to submit this form
- 1
Download The Agreement
Download the Authorization Agreement for Preauthorized Payments.
- 2
Complete The Agreement
Fill in the financial institution and account details, payment dates, service address, account number, printed name, and signature.
- 3
Attach A Voided Check
Attach a copy of a voided check to the form.
- 4
Submit The Agreement
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the preauthorized payment agreement do?
- It authorizes the Village of Ashley to debit the financial institution account listed on the form for utility payments.
- What information and attachment does the agreement ask for?
- It asks for financial institution and account details, payment dates, service address, account number, printed name, and signature. Attach a copy of a voided check.
- Do I need a notary for the preauthorized payment agreement?
- No. The agreement is signed without a notary; it requests a copy of a voided check, and the signer completes the payment dates and signs it.
- How do I submit the preauthorized payment agreement?
- The document does not give submission instructions. Submit it to the city department named on the form; check the city website for current contact details.