Russia, OH · Shelby County
Automatic Checking Account Debit Application For Payment Of Utilities
Russia utility customers use this application to authorize automatic checking-account withdrawals for monthly water and sewer bills.
What this form is
This application lets an account holder authorize the Village of Russia to withdraw payments for monthly water and sewer bills from a checking account. It asks for applicant and service address details, contact information, bank details, and the account holder’s signature and date. The application says automatic withdrawals continue until the account holder submits a written request to discontinue them.
Who needs it
A Village of Russia utility customer who wants monthly water and sewer bills paid by automatic checking-account withdrawal needs this application.
How to submit it
Attach a voided check and mail the application to Village of Russia - ACH, PO Box 361, Russia, Ohio 45363. The form says to allow two weeks for processing.
About notarization
This application is signed and dated without a notary; attach a voided check, and the form does not say that any attachment must be notarized or sworn.
How to submit this form
- 1
Download The Application
Download the automatic checking account debit application for utility payments.
- 2
Complete The Application
Enter applicant, billing and service address, contact, and bank information, then sign and date the application.
- 3
Attach A Voided Check
Include a voided check with the completed application.
- 4
Mail It To The Village
Mail the application and voided check to Village of Russia - ACH, PO Box 361, Russia, Ohio 45363.
Frequently asked questions
- What does the Russia automatic utility payment application authorize?
- It authorizes the Village of Russia to make automatic withdrawals from a checking account to pay monthly water and sewer bills.
- How do I submit the Russia utility payment application?
- Attach a voided check and mail the application to Village of Russia - ACH, PO Box 361, Russia, Ohio 45363. The form says to allow two weeks for processing.
- Do I need a notary for the Russia utility payment application?
- No. The account holder signs and dates the application without a notary. Attach a voided check; the form does not say the attachment must be notarized or sworn.