South Amherst, OH · Lorain County
Authorization for Direct Payment via ACH (ACH Debit)
South Amherst utility customers use this form to authorize recurring direct debits from a checking or savings account for utility payments.
What this form is
This form authorizes the Village of South Amherst Utility Department to debit a customer’s checking or savings account for payments. It sets the debit date as the 20th of each month, or the following business day if that date falls on a weekend or holiday. Account holders provide bank and account details, a maximum debit amount, and signatures; cancellation requires written or in-person notice at least 30 days ahead.
Who needs it
South Amherst utility customers who want the Utility Department to make recurring payments directly from a checking or savings account need this form.
How to submit it
Return the completed form to the Water Clerk by email at [email protected] or by mail to SAU – Clerk, 103 W. Main St., South Amherst, OH 44001.
About notarization
This document is signed without a notary; account holders sign and date it, and no notarized attachment or related step is identified.
How to submit this form
- 1
Download The Form
Download the South Amherst ACH debit authorization PDF.
- 2
Complete The Form
Enter account holder names, select checking or savings, provide bank and account details, and enter the maximum approved debit amount.
- 3
Sign And Date
Have the account holder or holders sign and date the authorization.
- 4
Submit To The Water Clerk
Email the form to [email protected] or mail it to SAU – Clerk, 103 W. Main St., South Amherst, OH 44001.
Frequently asked questions
- What does the ACH debit authorization form do?
- It authorizes the Village of South Amherst Utility Department to debit a checking or savings account for recurring payments, with the debit scheduled for the 20th of each month.
- What information must I provide?
- The form asks for account holder names, checking or savings account selection, bank name, routing number, account number, a maximum approved debit amount, and account holder signatures and dates.
- Do I need a notary for the ACH debit authorization?
- No. The form is signed and dated by the account holder; it identifies no notarized attachment or related step.
- How do I submit the ACH debit authorization?
- Return it to the Water Clerk by email at [email protected] or by mail to SAU – Clerk, 103 W. Main St., South Amherst, OH 44001.