West Alexandria, OH · Preble County
Recurring Payment Authorization Form
West Alexandria residents use this form to authorize recurring bank-account payments for their monthly water, sewer, and trash bill.
What this form is
This form authorizes the Village of West Alexandria to charge the account holder’s checking or savings account for the monthly water, sewer, and trash bill. It asks for service and contact details, the water bill account number, bank-account information, and a signature and date. It also describes payment timing, cancellation notice, and a possible $30 charge for each returned payment attempt due to insufficient funds.
Who needs it
Residents who want the village to collect their monthly water, sewer, and trash bill automatically 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 has no notary block; the account holder signs and dates it, with no notarized attachment or sworn step stated.
How to submit this form
- 1
Download The Form
Download the recurring payment authorization form.
- 2
Complete The Form
Enter your service, contact, water bill, and bank-account information, and indicate whether you want paperless billing.
- 3
Sign And Date
Sign and date the authorization.
- 4
Submit To The City
Submit the completed form 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 recurring payment authorization form?
- No. The form has no notary block, and no notarized attachment or sworn step is stated; the account holder signs and dates it.
- How do I submit the recurring payment authorization form?
- Submit it to the city department named on the form. Check the city website for current contact details.
- What information does the form ask for?
- It asks for service and contact details, a water bill account number, account type, the name on the bank account, bank name, routing number, and bank account number.
- What bills can this form pay automatically?
- The form authorizes recurring charges for the monthly water, sewer, and trash bill from a checking or savings account.