Fayette, OH · Fulton County
Direct Payment ACH Authorization Form
Fayette residents use this form to authorize automatic payments for water and sewer utility invoices from a checking or savings account.
What this form is
This form authorizes the Village of Fayette to make recurring ACH payments for a water and sewer utility invoice from a checking or savings account. To enroll, complete the account and financial institution details, sign and date the form, and attach a photocopy or voided check, a pre-encoded deposit ticket, or a bank verification letter. The authorization remains active until canceled in writing.
Who needs it
Fayette utility customers who want their water and sewer invoice payments automatically deducted from a checking or savings account need this form.
How to submit it
Return the completed form and required bank-document copy to the Village of Fayette offices at 102 W. Main Street, Fayette, OH 43521.
About notarization
This form is signed and dated without a notary; attach a check copy, voided check, pre-encoded deposit ticket, or bank verification letter.
How to submit this form
- 1
Download the Form
Download the Direct Payment ACH Authorization Form for the Village of Fayette.
- 2
Complete Account Details
Provide the name on the bank account, financial institution name, account number, and routing number.
- 3
Gather a Bank Document
Attach a check copy, voided check, pre-encoded deposit ticket, or bank verification letter.
- 4
Sign and Submit
Sign and date the form, then return it with the attachment to the Village of Fayette offices.
Frequently asked questions
- Do I need a notary for the Direct Payment ACH Authorization Form?
- No. Sign and date the form without a notary, and attach a check copy, voided check, pre-encoded deposit ticket, or bank verification letter.
- How do I submit the Direct Payment ACH Authorization Form?
- Return the completed form and required bank-document copy to the Village of Fayette offices at 102 W. Main Street, Fayette, OH 43521.
- What should I attach to the form?
- Attach a photocopy of a check, a voided check, a pre-encoded deposit ticket, or a bank verification letter from your financial institution.
- Which bills can I pay using this authorization?
- The form authorizes automatic payment of a water and sewer utility invoice from a checking or savings account.