Groveport, OH · Franklin County
ACH Payment Authorization Form
Groveport customers use this form to authorize a one-time withdrawal from their bank account for city services.
What this form is
This form authorizes the City of Groveport to make a one-time withdrawal from the account listed for services performed. Complete it when paying the city by ACH, providing the account holder and contact details, payment purpose and amount, account type, bank information, signature, and date. The form also instructs customers to include a voided check.
Who needs it
Customers paying for services performed by the City of Groveport can use this form to authorize a one-time withdrawal from their account.
How to submit it
Submit the form and a voided check to the City of Groveport, 655 Blacklick Street, Groveport, OH 43125; fax it to (614) 836-1953 or email it to [email protected].
About notarization
This form is signed and dated without a notary; include a voided check as instructed, and the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the ACH Payment Authorization Form from this page.
- 2
Complete The Form
Enter the account holder, contact, payment, and bank information, then sign and date the form.
- 3
Gather The Attachment
Include a voided check as instructed on the form.
- 4
Submit To The City
Send the form and voided check to the city by mail, fax, or email using the listed contact details.
Frequently asked questions
- Do I need a notary for the ACH Payment Authorization Form?
- No. The form calls for an authorized signature and date, not a notary. Include a voided check as instructed.
- How do I submit the ACH Payment Authorization Form?
- Send the completed form and a voided check to the City of Groveport by mail, fax, or email using the contact details on the form.
- What information does the form ask for?
- It asks for account holder and contact details, payment purpose and amount, account type, bank information, an authorized signature, and the date.
- What does signing the form authorize?
- The signature authorizes the City of Groveport to make a one-time withdrawal from the listed account for services performed.