DuBois, PA · Clearfield County
Water ACH Bank Form
The Water ACH Bank Form authorizes the City of DuBois to initiate automated clearinghouse entries to a customer’s bank account.
What this form is
Customers use this form to authorize the City of DuBois to initiate automated clearinghouse entries to a checking or savings account. It requests customer and bank details, account and routing numbers, account type, date, and signatures; joint accounts include a second account-holder name and signature. The form instructs customers to include a voided check.
Who needs it
A water customer who wants to authorize automated clearinghouse entries to a checking or savings account can complete this form.
How to submit it
The form identifies the Bureau of Water and lists the City address and fax number. Include a voided check with the form.
About notarization
This form has no notary block; the customer signs and dates it and includes a voided check.
How to submit this form
- 1
Download The Form
Download the Water ACH Bank Form PDF.
- 2
Complete The Form
Enter customer and bank information, select checking or savings, and provide the account and routing numbers.
- 3
Sign And Date
Add the date and required signature; include the joint account holder’s name and signature if applicable.
- 4
Gather The Attachment
Include a voided check as instructed on the form.
- 5
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
- Do I need a notary for the Water ACH Bank Form?
- No. The form has no notary block; the customer signs and dates it and includes a voided check.
- How do I submit the Water ACH Bank Form?
- The form identifies the Bureau of Water and lists the City address and fax number, but gives no submission instructions. Include a voided check; check the city website for current contact details.
- What information does the Water ACH Bank Form ask for?
- It asks for customer and bank details, checking or savings account type, routing and account numbers, a date, and signatures. Joint accounts include a second account-holder name and signature.
- Do I need to include anything with the form?
- Yes. The form says to include a voided check.