Do I need a notary for the Utilities Auto Pay Authorization Form?

No. This form is signed without a notary. Attach a blank or voided check; the form does not mention a notarized or sworn attachment.

How do I submit the Utilities Auto Pay Authorization Form?

The form does not provide submission instructions. Submit it to the city department named on the form and check the city website for current contact details.

What information does the form ask for?

It asks for your name, address, telephone number, financial institution and branch, city, state, ZIP code, checking account number, routing number, and signature.

What must I attach to the authorization form?

The form asks you to attach a blank or voided check. It authorizes deduction of the full bill amount on the 15th of each month.

St. Henry, OH · Mercer County

No notary required

Utilities Auto Pay Authorization Form

This form lets St. Henry utility customers authorize automatic monthly payments from a checking or savings account for their bill.

What this form is

Utility customers use this form to authorize the Village of St. Henry to deduct the full bill amount from a listed checking or savings account on the 15th of each month. It asks for customer contact details, financial institution and account information, and a signature. The form also requests a blank or voided check and explains that cancellation requires written notice 30 days in advance.

Who needs it

St. Henry utility customers who want the Village to automatically deduct their full monthly bill from a checking or savings account need this form.

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 form is signed without a notary; attach a blank or voided check, and no notarized or sworn attachment is mentioned.

How to submit this form

1
Download The Form
Download the Utilities Auto Pay Authorization Form PDF.
2
Complete The Form
Print legibly and provide your contact details, financial institution information, account number, routing number, and signature.
3
Gather The Attachment
Attach a blank or voided check as requested on the form.
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

Do I need a notary for the Utilities Auto Pay Authorization Form?: No. This form is signed without a notary. Attach a blank or voided check; the form does not mention a notarized or sworn attachment.
How do I submit the Utilities Auto Pay Authorization Form?: The form does not provide submission instructions. Submit it to the city department named on the form and check the city website for current contact details.
What information does the form ask for?: It asks for your name, address, telephone number, financial institution and branch, city, state, ZIP code, checking account number, routing number, and signature.
What must I attach to the authorization form?: The form asks you to attach a blank or voided check. It authorizes deduction of the full bill amount on the 15th of each month.

Need something notarized?

This Utilities Auto Pay Authorization Form doesn’t need a notary — but if you have another St. Henry form that does, a commissioned online notary can help.