Fort Loramie, OH · Shelby County
Authorization for Direct Payment via ACH
This form lets Fort Loramie utility customers authorize the village to debit a checking or savings account for utility bill payments.
What this form is
Utility customers use this authorization to allow the Village of Fort Loramie to debit a selected checking or savings account for utility bill payments. The form asks for the utility account number, account holder name, bank routing and account numbers, financial institution city and state, and signatures. It says customers will receive notice if the payment amount changes and asks them to attach a voided check.
Who needs it
Fort Loramie utility customers who want the village to debit a checking or savings account for utility bill payments need this authorization.
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 as requested, and no sworn or notarized attachment is mentioned.
How to submit this form
- 1
Download The Form
Download the ACH utility payment authorization form.
- 2
Complete The Authorization
Select checking or savings and enter the utility account, account holder, bank, and financial account details requested.
- 3
Gather The Attachment
Attach a voided check as requested and keep a copy of the authorization for your records.
- 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 ACH utility payment authorization?
- No. The form has signature and date fields but no notary block. It asks you to attach a voided check; no sworn or notarized attachment is mentioned.
- How do I submit the ACH utility payment 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.
- What information does the ACH authorization ask for?
- It asks for your utility account number, account holder name, routing number, account number, financial institution city and state, and signatures. Select checking or savings.
- What attachment does the form request?
- The form asks you to staple a voided check to the authorization and says to keep a copy of the authorization for your records.