Waynesville, OH · Warren County
ACH Automatic Payment Authorization
Utility customers use this authorization to let the Village of Waynesville debit payments from a designated checking or savings account.
What this form is
This authorization lets the Village of Waynesville initiate automatic payment debits from the financial account provided by a utility customer. It asks for customer and service address details, a utility account number, financial institution and account information, an account type, and the date of the first ACH payment. The form also requests a voided check or deposit ticket and a dated signature.
Who needs it
A Village of Waynesville utility customer who wants to authorize automatic payments from a checking or savings account needs 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 document is signed without a notary; the signer dates and signs the authorization, with no notarized attachment or related step mentioned.
How to submit this form
- 1
Download The Application
Download the ACH automatic payment authorization form.
- 2
Complete Customer Details
Enter your name, address, phone number, service address, and utility account number.
- 3
Provide Bank Information
Fill in the financial institution and account details, select the account type, and provide the first ACH payment date.
- 4
Gather The Attachment
Enclose a copy of a voided check or deposit ticket.
- 5
Sign And Submit
Date and sign the authorization, then submit it to the city department named on the form.
Frequently asked questions
- What does the ACH application authorize?
- It authorizes the Village of Waynesville to initiate debit entries from the financial account listed on the form for automatic utility payments.
- What information and attachment does the form request?
- It requests customer, service address, utility account, and financial institution details, plus the first payment date. Enclose a copy of a voided check or deposit ticket.
- Do I need a notary for the ACH application?
- No. The document is signed and dated without a notary, and it mentions no notarized attachment or related step.
- How do I submit the ACH application?
- The document does not provide a submission address or method. Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This ACH Automatic Payment Authorization doesn’t need a notary — but if you have another Waynesville form that does, a commissioned online notary can help.