Bloomdale, OH · Wood County
Electric ACH Authorization Form
This form lets Bloomdale electric customers authorize pre-authorized payments from a checking or savings account.
What this form is
Use this authorization to allow the Village of Bloomdale to debit payments from the bank account you identify for electric service. The form asks for the client’s name and address, financial institution, routing number, account type, account number, date, and signature; the authorization continues until written notice of termination is received.
Who needs it
Electric customers who want to authorize pre-authorized payments from a checking or savings account can complete 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 authorization is signed and dated without a notary; the form mentions no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download the Form
Download the Electric ACH Authorization Form.
- 2
Complete the Form
Enter the requested client, bank, and account information, then date and sign the authorization.
- 3
Check for Attachments
The form does not identify any attachments.
- 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
- What does the Electric ACH Authorization Form do?
- It authorizes the Village of Bloomdale to debit the account you identify for pre-authorized payments.
- What information does the form ask for?
- It asks for your name and address, financial institution, routing number, checking or savings account type, account number, date, and signature.
- Do I need a notary for the Electric ACH Authorization Form?
- No. The form is signed and dated without a notary, and it mentions no notarized or sworn attachment.
- How do I submit the Electric ACH Authorization Form?
- 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.