LaGrange, OH · Lorain County
ACH Revocation Authorization
LaGrange utility account holders use this form to request termination of preauthorized bank debits for their utility payments.
What this form is
This form lets a LaGrange Utilities account holder request that preauthorized debit payments from a bank account be terminated. It asks for utility account, service address, contact, and banking information, plus the requested effective date and the account holder’s signature and date. The form notes that auto-pay revocations must be processed two business days before the bill’s due date; otherwise, the change takes effect with the next billing cycle.
Who needs it
A LaGrange Utilities account holder who wants to stop automatic withdrawals from a bank account for utility payments should complete this form.
How to submit it
Return the completed application to LaGrange Utilities, as instructed on the form.
About notarization
This document is signed and dated without a notary; the signer just signs and dates the authorization.
How to submit this form
- 1
Download The Form
Download the ACH Revocation Authorization for LaGrange Utilities.
- 2
Complete The Form
Enter the utility account, service, contact, and banking information, and specify when you want the debit to end.
- 3
Sign And Date
Sign and date the authorization, and print your name.
- 4
Return The Form
Return the completed application to LaGrange Utilities.
Frequently asked questions
- What does the ACH Revocation Authorization do?
- It lets a LaGrange Utilities account holder request termination of preauthorized debit payments from a bank account. The account holder is then responsible for making monthly payments by the due date.
- What information does the form ask for?
- It asks for the utility account holder’s name, utility account number, service address, phone number, financial institution and bank account details, as well as the requested effective date.
- Do I need a notary for the ACH Revocation Authorization?
- No. The document is signed and dated without a notary; the signer just signs and dates the authorization.
- How do I submit the ACH Revocation Authorization?
- Return the completed application to LaGrange Utilities, as instructed on the form.