LaGrange, OH · Lorain County
Direct Debit (ACH) Authorization Form
Utility customers use this form to authorize or update electronic debit payments from a checking or savings account for their LaGrange Utilities account.
What this form is
This form authorizes LaGrange Utilities and the listed financial institution to make electronic debit entries, and, if necessary, credit entries, to a utility customer's account. Use it to start or update ACH payments; the form does not state when authorization is required. It asks for the service address, utility account and contact details, financial institution, routing and account numbers, account type, and the customer's signature and date.
Who needs it
LaGrange Utilities customers who want to authorize or update electronic payments from a checking or savings account should complete this form.
How to submit it
Return the completed form to 301 Liberty Street, La Grange, Ohio 44035, or email it to [email protected].
About notarization
This document is signed and dated without a notary; it lists no attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download The Form
Download the Direct Debit (ACH) Authorization Form.
- 2
Complete The Form
Enter the service address, utility account and contact details, bank information, account type, and whether this is a new authorization or an update.
- 3
Sign And Date
Sign and date the authorization. The form lists no attachment to gather.
- 4
Submit To LaGrange Utilities
Return it to 301 Liberty Street, La Grange, Ohio 44035, or email it to [email protected].
Frequently asked questions
- What does the Direct Debit (ACH) Authorization Form do?
- It authorizes LaGrange Utilities and the listed financial institution to make electronic debit entries, and if necessary credit entries, to the account provided.
- What information does the form ask for?
- It asks for service and utility account details, customer contact information, financial institution, routing and account numbers, checking or savings selection, and a signature and date.
- Do I need a notary for the Direct Debit (ACH) Authorization Form?
- No. This document is signed and dated without a notary, and it lists no attachment or related step that must be notarized or sworn.
- How do I submit the Direct Debit (ACH) Authorization Form?
- Return it to 301 Liberty Street, La Grange, Ohio 44035, or email it to [email protected].