Covington, OH · Miami County
ACH Automatic Withdraw Authorization
Covington utility customers complete this authorization to request automatic withdrawals from a bank account for monthly utility bills.
What this form is
Covington utility customers use this form to authorize the Village to debit a bank account for monthly utility bills. The form asks for bank and customer contact details, bank routing and account numbers, and the utility account numbers to include. Customers must sign and date the authorization and attach a voided check for the account to be debited.
Who needs it
A Covington utility customer requesting automatic withdrawal of funds from a bank account to pay monthly utility bills needs 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 authorization is signed and dated without a notary; attach a voided check for the account to be debited to help verify account and routing numbers.
How to submit this form
- 1
Download The Form
Download the ACH Automatic Withdraw Authorization PDF.
- 2
Complete The Form
Provide the requested bank, customer, and utility account information.
- 3
Attach A Voided Check
Include a voided check for the account to be debited.
- 4
Sign And Submit
Print your name, sign and date the authorization, then submit it to the city department named on the form.
Frequently asked questions
- What does the ACH Automatic Withdraw Authorization do?
- It authorizes the Village of Covington to debit the listed bank account electronically or by another commercially accepted method for monthly utility bills.
- What should I include with the authorization?
- Attach a voided check for the bank account to be debited. The form says this helps verify the accuracy of the account and routing numbers.
- Do I need a notary for the ACH Automatic Withdraw Authorization?
- No. The authorization is signed and dated without a notary; attach a voided check for the account to be debited.
- How do I submit the ACH authorization?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This ACH Automatic Withdraw Authorization doesn’t need a notary — but if you have another Covington form that does, a commissioned online notary can help.