Franklin, PA · Cambria County
Authorization Agreement for Direct Debit Payment
Franklin customers use this agreement to authorize monthly bank-account withdrawals for water, sewer, garbage, and additional unpaid fees at a service address.
What this form is
This agreement authorizes the City of Franklin to debit the total due for water, sewer, garbage, and additional unpaid fees from the listed bank account on the 15th of each month. It asks for the customer and service address, account type, financial institution and account details, and customer signature and date. The form also directs the customer to attach a voided check.
Who needs it
A Franklin customer who wants the city to withdraw monthly utility charges and additional unpaid fees from a checking or savings account needs 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 authorization is signed and dated without a notary; attach a voided check as directed on the form.
How to submit this form
- 1
Download The Form
Download the direct debit authorization form.
- 2
Complete The Form
Enter the customer, service address, bank, and account information; select checking or savings and sign and date the authorization.
- 3
Attach A Voided Check
Attach a voided check as directed on the form.
- 4
Submit To The City
Submit the completed form to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the direct debit authorization?
- No. The authorization calls for the customer’s signature and date, not a notary. Attach a voided check as directed on the form.
- How do I submit the direct debit authorization?
- Submit it to the city department named on the form; check the city website for current contact details.
- What charges can the city debit?
- The form authorizes deductions for the total due for water, sewer, garbage, and any additional unpaid fees on the listed service address.
- What information does the form request?
- It requests customer and service-address information, checking or savings selection, financial institution and bank-account details, and the customer’s signature and date.