Spring Grove, PA · York County
ACH Authorization Form
Spring Grove account holders use this form to authorize ACH entries to a checking or savings account and provide the financial institution and account details.
What this form is
This form authorizes the Borough of Spring Grove and Susquehanna Bank to initiate entries to a checking or savings account and make adjustments for transactions credited in error. It asks for financial institution, account, routing, contact, signature, and date information. The form also instructs the signer to attach a voided check and explains how to revoke authorization or stop payment.
Who needs it
An account holder who wants to authorize ACH entries to a checking or savings account through the Borough of Spring Grove and Susquehanna Bank needs this form.
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 form is signed and dated without a notary; attach a voided check as instructed.
How to submit this form
- 1
Download the Form
Download the ACH Authorization Form PDF.
- 2
Complete the Form
Provide the requested financial institution and account details, then sign and date the form.
- 3
Attach a Voided Check
Attach a voided check where indicated on the 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 ACH Authorization Form do?
- It authorizes the Borough of Spring Grove and Susquehanna Bank to initiate entries to a checking or savings account and make adjustments for transactions credited in error.
- What information and attachment does the form request?
- It requests financial institution, account, routing, contact, signature, and date information. It also instructs the signer to attach a voided check.
- Do I need a notary for the ACH Authorization Form?
- No. This form is signed and dated without a notary; attach a voided check as instructed.
- How do I submit the ACH Authorization Form?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This ACH Authorization Form doesn’t need a notary — but if you have another Spring Grove form that does, a commissioned online notary can help.