Do I need a notary for the Utility Bill Authorization?

No. The form asks for a signature and date, not notarization. It does require a copy of a voided check, which the form does not identify as notarized or sworn.

What does this form authorize?

It authorizes the Village of Anna to make electronic entries to the listed bank account and to send the utility bill by email instead of providing a hard copy.

What information and attachment does the form request?

Provide your name, utility account number, address, phone number, email address, bank name, ABA number, and checking or savings account number. Sign and date the form and attach a copy of a voided check.

Anna, OH · Shelby County

No notary required

Utility Bill ACH Debit and Email Billing Authorization

Anna utility customers use this form to authorize automatic bank-account debits and receive utility bills by email instead of paper.

What this form is

This form authorizes the Village of Anna to make electronic entries to the utility customer’s bank account and to send the utility bill by email instead of providing a hard copy. It asks for the customer’s contact and utility account details, bank information, and signature and date. The signer must attach a copy of a voided check; the authorization remains in effect until written cancellation and the service is paid in full.

Who needs it

Anna utility customers who want to authorize automatic bank debits and receive their utility bills by email should complete 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 and dated without a notary; attach a copy of a voided check, which the form does not identify as notarized or sworn.

How to submit this form

1
Download The Form
Download the Utility Bill Authorization PDF.
2
Complete The Form
Print clearly and provide your utility, contact, and bank account information. Sign and date the authorization.
3
Gather The Attachment
Attach a copy of a voided check as the form directs.
4
Submit To The City
Submit the completed form using the city’s current contact details.

Frequently asked questions

Do I need a notary for the Utility Bill Authorization?: No. The form asks for a signature and date, not notarization. It does require a copy of a voided check, which the form does not identify as notarized or sworn.
What does this form authorize?: It authorizes the Village of Anna to make electronic entries to the listed bank account and to send the utility bill by email instead of providing a hard copy.
What information and attachment does the form request?: Provide your name, utility account number, address, phone number, email address, bank name, ABA number, and checking or savings account number. Sign and date the form and attach a copy of a voided check.
How do I submit the Utility Bill Authorization?: The form does not give submission instructions. Submit it to the city department named on the form; check the city website for current contact details.

Need something notarized?

This Utility Bill ACH Debit and Email Billing Authorization doesn’t need a notary — but if you have another Anna form that does, a commissioned online notary can help.