Wellsboro, PA · Tioga County
Consumer Debit Authorization
Wellsboro residents use this form to authorize recurring utility payments to be deducted directly from a checking or savings account.
What this form is
This form enrolls a customer in recurring direct payment of utility bills from a checking or savings account. It asks for the customer’s name, billing address, phone number, financial institution, routing and account numbers, and payment amount. The signer authorizes the Borough of Wellsboro to deduct utility payments and must enclose a voided check.
Who needs it
Wellsboro utility customers who want recurring payments deducted from a checking or savings account should complete this authorization.
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 without a notary; the signer just signs and dates it and encloses a voided check.
How to submit this form
- 1
Download The Form
Download the Consumer Debit Authorization PDF.
- 2
Complete The Form
Fill in your contact, billing, and bank account information, and select checking or savings.
- 3
Gather The Attachment
Enclose a voided check with the completed form.
- 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 Consumer Debit Authorization do?
- It authorizes the Borough of Wellsboro to deduct recurring utility payments from the checking or savings account listed on the form.
- What should I include with the form?
- Complete the account and contact information, sign and date the authorization, and enclose a voided check.
- Do I need a notary for the Consumer Debit Authorization?
- No. The form does not require a notary; the signer just signs and dates it and encloses a voided check.
- How do I submit the Consumer Debit Authorization?
- Submit it to the city department named on the form; check the city website for current contact details.