Do I need a notary for the ACH Authorization Form?

No. The form is signed without a notary. Attach an unused voided check for a checking account or a savings deposit ticket for a savings account.

What bank information does the form ask for?

It asks for your bank routing number, checking or savings account number, financial institution name and address, and phone number, along with your contact details.

What attachment should I include?

Attach an unused voided check if you use a checking account, or a savings deposit ticket if you use a savings account.

Richfield, OH · Summit County

No notary required

Automated Clearing House Authorization Form

This form authorizes the Village of Richfield to automatically deduct quarterly utility bill payments from a resident’s checking or savings account.

What this form is

This ACH authorization lets the Village of Richfield deduct the net amount due on a current quarterly utility bill from the account you identify. It remains in effect until you provide written termination notice, and the village may end the service if a withdrawal is returned unpaid. The form requests your sewer account and service details, bank and account information, contact details, and signature; include a voided check or savings deposit ticket.

Who needs it

Richfield utility customers who want quarterly bill payments automatically deducted from a checking or savings account should complete this form.

How to submit it

Submit it to the Village of Richfield Finance Department at 4410 W. Streetsboro Road, Richfield, OH 44286. The form lists no email or online submission method.

About notarization

This form is signed without a notary; attach an unused voided check for checking or a savings deposit ticket for savings.

How to submit this form

1
Download The Form
Download the Automated Clearing House Authorization Form.
2
Complete The Form
Provide your sewer account and service address, bank and account information, contact details, and signature.
3
Gather The Attachment
Attach an unused voided check for checking or a savings deposit ticket for savings.
4
Submit To The Finance Department
Submit the completed form to the Village of Richfield Finance Department at 4410 W. Streetsboro Road, Richfield, OH 44286.

Frequently asked questions

Do I need a notary for the ACH Authorization Form?: No. The form is signed without a notary. Attach an unused voided check for a checking account or a savings deposit ticket for a savings account.
How do I submit the ACH Authorization Form?: Submit it to the Village of Richfield Finance Department at 4410 W. Streetsboro Road, Richfield, OH 44286. The form does not list an email or online submission method.
What bank information does the form ask for?: It asks for your bank routing number, checking or savings account number, financial institution name and address, and phone number, along with your contact details.
What attachment should I include?: Attach an unused voided check if you use a checking account, or a savings deposit ticket if you use a savings account.

Need something notarized?

This Automated Clearing House Authorization Form doesn’t need a notary — but if you have another Richfield form that does, a commissioned online notary can help.