Montpelier, OH · Williams County
Authorization to Transmit Funds Via ACH Debits
This agreement lets a customer authorize the Village of Montpelier to process ACH debit transactions using the provided account and utility information.
What this form is
The Authorization to Transmit Funds Via ACH Debits is an agreement between the Village of Montpelier and a customer. Completing and signing it authorizes the Village to process ACH debit transactions. The form asks for contact details, financial institution and account information, a utility account number, and the signer’s name, signature, and date; it also lists attachments for account verification.
Who needs it
A customer who wants the Village of Montpelier to process ACH debit transactions should complete and sign this agreement.
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; attach a voided check, or savings account verification, as applicable, and sign and date the agreement.
How to submit this form
- 1
Download the Agreement
Download the ACH debit authorization agreement PDF.
- 2
Complete the Customer Information
Enter your contact, financial institution, account, and utility account information.
- 3
Gather Account Verification
Attach a voided check, or savings account and routing number verification if applicable.
- 4
Sign and Submit
Sign and date the agreement, then submit it to the city department named on the form.
Frequently asked questions
- Do I need a notary for the ACH debit authorization agreement?
- No. The agreement is signed without a notary. Attach a voided check, or verification of the account and routing number if using a savings account.
- How do I submit the ACH debit authorization agreement?
- Submit it to the city department named on the form; check the city website for current contact details.
- What information does the agreement ask for?
- It asks for your name, phone, address, financial institution, routing number, checking or savings account number, utility account number, signature, and date.
- What should I attach to the agreement?
- The form requests a voided check for verification. If you use a savings account, attach verification of the account and routing number.
Need something notarized?
This Authorization to Transmit Funds Via ACH Debits doesn’t need a notary — but if you have another Montpelier form that does, a commissioned online notary can help.