Keene, TX · Johnson County
Authorization Agreement for ACH Debit
Keene customers use this agreement to authorize monthly water charges to be debited from a specified checking or savings account.
What this form is
This agreement authorizes the City of Keene to debit monthly charges from the customer’s specified financial institution account. It asks for customer and service details, bank information, account type, and a signature and date. The form says charges will be debited between the first and seventh of each month, and requires a voided check or copy of one to be attached.
Who needs it
Keene customers who want monthly charges debited from a checking or savings account should complete and submit this agreement.
How to submit it
Send it to Keene City Hall at 1000 N. Old Betsy Rd, Cleburne, Texas 76031, fax it to 817-556-2060, or email it to [email protected].
About notarization
This agreement is signed and dated without a notary; attach a voided check or a copy of a voided check.
How to submit this form
- 1
Download The Agreement
Download the Authorization Agreement for ACH Debit.
- 2
Complete The Form
Enter your customer, service, and bank account information, then sign and date the agreement.
- 3
Attach A Voided Check
Attach a voided check or a copy of a voided check.
- 4
Submit To The City
Send, fax, or email the completed agreement to Keene City Hall using the contact details on the form.
Frequently asked questions
- Do I need a notary for the ACH debit authorization agreement?
- No. Sign and date the agreement without a notary, and attach a voided check or a copy of a voided check.
- How do I submit the ACH debit authorization agreement?
- Send it to Keene City Hall at the address on the form, fax it to 817-556-2060, or email it to [email protected].
- What information does the agreement ask for?
- It asks for customer and service details, financial institution information, routing and account numbers, account type, and a signature and date.
- When are monthly charges debited?
- The agreement states that monthly charges will be debited between the first and seventh of each month.
Need something notarized?
This Authorization Agreement for ACH Debit doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.