New Freedom, PA · York County
Automatic Cash Transfer (ACH) Application Form
New Freedom Borough utility customers use this application to authorize recurring payments from a checking or savings account.
What this form is
This application enrolls a utility customer in New Freedom Borough’s optional, free automatic payment program. It asks for contact, utility account, and bank account details, and authorizes the Borough to withdraw the full balance due on each bill’s due date. Checking account applicants are asked to enclose a voided check; the form also offers a separate, optional paperless billing signup.
Who needs it
New Freedom Borough utility customers who want their full bill balance withdrawn automatically from a checking or savings account should complete this application.
How to submit it
Return the signed form to New Freedom Borough, 49 East High Street, New Freedom, PA 17349. Enclose a voided check if applying with a checking account.
About notarization
This document is signed without a notary; checking account applicants should enclose a voided check, and the signer signs and dates the form.
How to submit this form
- 1
Download The Application
Download the Automatic Cash Transfer (ACH) Application Form.
- 2
Complete The Form
Provide your contact, utility account, and bank account information, then sign and date the authorization.
- 3
Gather Any Attachment
If you select checking, enclose a voided check.
- 4
Return It To The Borough
Send the signed form to New Freedom Borough, 49 East High Street, New Freedom, PA 17349.
Frequently asked questions
- Do I need a notary for the Automatic Cash Transfer Application?
- No. The form is signed and dated without a notary. If you choose checking, enclose a voided check.
- How do I submit the ACH application?
- Return the signed form to New Freedom Borough, 49 East High Street, New Freedom, PA 17349. Enclose a voided check if applying with a checking account.
- What information does the application ask for?
- It asks for your name, service address, phone number, utility account number, financial institution, account holder name, and bank routing and account numbers.
- Can I sign up for paperless billing on this form?
- Yes. The form includes a separate, optional paperless billing signup where you can request monthly invoices by email and provide an email address.