Nesquehoning, PA · Carbon County
Automatic Cash Transfer ACH Application Form
Nesquehoning sewer or sanitation customers use this application to authorize automatic monthly payments from a checking or savings account.
What this form is
This form enrolls a property’s sewer or sanitation account in automatic payments from a checking or savings account. It asks for customer, service, billing, and bank account details, and includes an authorization for charges on the 20th of each month. Checking account applicants must enclose a voided check; tenants are asked to provide the owner’s name and address.
Who needs it
Nesquehoning property owners or tenants who want sewer or sanitation bill payments withdrawn automatically can complete this application.
How to submit it
Return the signed form to Borough of Nesquehoning, 114 W. Catawissa Street, Nesquehoning, PA 18240, as listed on the form. Call 570-669-9588 with questions.
About notarization
This document is signed and dated without a notary; the signer just signs and dates the authorization.
How to submit this form
- 1
Download The Form
Download the Automatic Cash Transfer ACH Application Form.
- 2
Complete The Application
Provide your contact, service, billing, sewer or sanitation account, and bank account information.
- 3
Gather Any Attachment
If paying from a checking account, enclose a voided check. For a savings account, obtain the routing and account numbers from your bank.
- 4
Sign And Submit
Sign and date the authorization, then return the form to Borough of Nesquehoning at the address printed on it.
Frequently asked questions
- Do I need a notary for the ACH application?
- No. The form has no notary block; the signer signs and dates the authorization. A checking account applicant must enclose a voided check.
- How do I submit the ACH application?
- Return the signed form to Borough of Nesquehoning, 114 W. Catawissa Street, Nesquehoning, PA 18240. Call 570-669-9588 with questions.
- What information does the ACH application request?
- It asks for your name, service and billing addresses, phone number, sewer or sanitation account number, financial institution, and checking or savings account details.
- What should I attach if I use a checking account?
- The form says to enclose a voided check for a checking account. For a savings account, it says to obtain the routing and account numbers from the bank.