Union, OH · Montgomery County
Request for Automatic Payment of Utility Bills
Union utility customers use this form to authorize automatic monthly withdrawals from a checking or savings account to pay their City utility bills.
What this form is
This form authorizes the City of Union Finance Department and the customer’s financial institution to withdraw monthly utility bill payments from a checking or savings account. Customers provide contact, service address, and bank account information, and agree that withdrawals occur on the bill’s due date. The authorization remains active until the customer requests cancellation in writing.
Who needs it
Union utility customers who want monthly bills automatically withdrawn from a checking or savings account should complete and return this form.
How to submit it
Return the completed form to the City of Union Finance Director, 118 N. Main St., Union, Ohio 45322. Attach a voided check or savings deposit ticket for account-number verification.
About notarization
This form is signed and dated without a notary; attach a voided check or savings deposit ticket for account-number verification.
How to submit this form
- 1
Download The Form
Download the Request for Automatic Payment of Utility Bills.
- 2
Complete The Form
Enter customer, service address, phone, financial institution, account, and routing information; then sign and date.
- 3
Gather The Attachment
Attach a voided check or, for a savings account, a deposit ticket for account-number verification.
- 4
Return It To The City
Send the completed form and attachment to the City of Union Finance Director at 118 N. Main St., Union, Ohio 45322.
Frequently asked questions
- Do I need a notary for the automatic utility bill payment request?
- No. Sign and date the form without a notary. Attach a voided check or a deposit ticket for a savings account to verify the account number.
- How do I submit the automatic utility bill payment request?
- Return the completed form to the City of Union Finance Director at 118 N. Main St., Union, Ohio 45322, with the required account-verification attachment.
- What account information does the form request?
- The form asks for customer and service address details, daytime phone number, financial institution and branch information, address, account and routing numbers, and checking or savings account type.
- What should I attach to the form?
- Attach a voided check for a checking account or a deposit ticket for a savings account. The form says this attachment is for account-number verification.
Need something notarized?
This Request for Automatic Payment of Utility Bills doesn’t need a notary — but if you have another Union form that does, a commissioned online notary can help.