Celina, OH · Mercer County
Authorization for Automatic Payment
Celina Utilities customers use this authorization to allow automatic payments from a checking or savings account for their utility account.
What this form is
This agreement authorizes Celina Utilities to make credit entries to the customer’s checking or savings account and to correct credit-entry errors with debits or adjustments. Customers use it to authorize automatic payments and provide bank, customer, and account details. It remains effective until Celina Utilities receives written notice to terminate it, and the form includes spaces for owner and utility representative signatures.
Who needs it
Celina Utilities customers who want to authorize automatic payments from a checking or savings account should complete this agreement.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed and dated without a notary; it lists no notarized attachment or sworn step, so the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the Authorization for Automatic Payment PDF.
- 2
Complete The Form
Enter the bank, account, and customer details requested, then provide the date and owner signature.
- 3
Check For Attachments
The document does not list any attachments.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the automatic payment authorization do?
- It authorizes Celina Utilities to initiate credit entries and, if needed, debit entries or adjustments for credit entries in error to the listed checking or savings account.
- What information does the form request?
- It asks for bank name, account and routing numbers, account type, customer name and contact details, customer account number, date, and signatures.
- Do I need a notary for the automatic payment authorization?
- No. This document is signed and dated without a notary; it lists no notarized attachment or sworn step.
- How do I submit the automatic payment authorization?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Authorization for Automatic Payment doesn’t need a notary — but if you have another Celina form that does, a commissioned online notary can help.