Arcadia, OH · Hancock County
Credit/Debit Authorization Form
This form lets a customer or employee authorize the Village of Arcadia to charge or credit a checking or savings account.
What this form is
Use this form to authorize the Village of Arcadia to make a charge or credit entry to a checking or savings account and correct transaction errors. It asks for financial institution and account details, the customer or employee’s printed name, signature, and date. For a charge, the form offers a set or maximum amount option and asks for a copy of a canceled check or deposit slip.
Who needs it
A customer or employee who wants to authorize the Village of Arcadia to charge or credit a checking or savings account should complete this form.
How to submit it
Send it to the Village of Arcadia Utility Department, 104 S Gibson St, P. O. Box 235, Arcadia Ohio 44804. The form also lists a fax number: (419) 894-6316.
About notarization
This document is signed without a notary; the signer signs and dates it and attaches a copy of a canceled check or deposit slip.
How to submit this form
- 1
Download The Form
Download the Credit/Debit Authorization Form.
- 2
Complete The Form
Select a charge or credit entry and provide the requested institution, account, name, signature, and date information.
- 3
Gather The Attachment
Attach a copy of a canceled check or deposit slip.
- 4
Submit To The Utility Department
Send the form to the Village of Arcadia Utility Department at the address listed, or fax it to the listed number.
Frequently asked questions
- Who uses the Credit/Debit Authorization Form?
- A customer or employee can use it to authorize the Village of Arcadia to make a charge or credit entry to a checking or savings account.
- What should I attach to the form?
- Attach a copy of a canceled check or deposit slip. The form also asks for financial institution and account information, a printed name, signature, and date.
- Do I need a notary for the Credit/Debit Authorization Form?
- No. This document is signed without a notary; sign and date it, then attach a copy of a canceled check or deposit slip.
- How do I submit the Credit/Debit Authorization Form?
- Send it to the Village of Arcadia Utility Department at 104 S Gibson St, P. O. Box 235, Arcadia Ohio 44804, or fax it to (419) 894-6316.