Do I need a notary for the automatic bill payment authorization?

No. Sign and date this form without a notary, and attach a voided check when you return it.

How do I submit the automatic bill payment authorization?

Complete all sections, sign and date the form, and attach a voided check. The form does not list a return destination; check the Borough website for current contact details.

What information does the form ask for?

It asks for applicant contact information, the service address, the financial institution, the account number, and whether the account is checking or savings.

Hollidaysburg, PA · Blair County

No notary required

Authorization for Automatic Bill Payment

This authorization form lets a Borough of Hollidaysburg water or sewer account holder request automatic payments from a bank or other financial institution.

What this form is

Use this form to authorize the Borough of Hollidaysburg to instruct your bank, savings and loan, or credit union to make water or sewer payments for the listed account. Complete all sections with applicant, service address, and financial institution details, then sign and date the form. The form asks you to attach a voided check when returning it.

Who needs it

A Borough water or sewer account holder who wants payments for the listed account made automatically through a financial institution 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 and dated without a notary; attach a voided check with the returned form.

How to submit this form

1
Download The Form
Download the Authorization for Automatic Bill Payment form.
2
Complete The Form
Fill in all sections, including applicant, service address, and financial institution information.
3
Gather The Attachment
Attach a voided check with the completed form.
4
Sign And Date
Sign and date the authorization.
5
Return The Form
Return the form to the Borough; check its website for current contact details.

Frequently asked questions

Do I need a notary for the automatic bill payment authorization?: No. Sign and date this form without a notary, and attach a voided check when you return it.
How do I submit the automatic bill payment authorization?: Complete all sections, sign and date the form, and attach a voided check. The form does not list a return destination; check the Borough website for current contact details.
What information does the form ask for?: It asks for applicant contact information, the service address, the financial institution, the account number, and whether the account is checking or savings.

Need something notarized?

This Authorization for Automatic Bill Payment doesn’t need a notary — but if you have another Hollidaysburg form that does, a commissioned online notary can help.