Altavista, VA · Campbell County
Automatic Payment Plan Application Form
Altavista utility customers use this application to authorize automatic withdrawals for bills at their service address and submit it with a voided check.
What this form is
This application authorizes the Town of Altavista to withdraw utility bill charges automatically from a checking or savings account. Customers complete it to enroll in the automatic payment plan, which the form says is currently offered only for utility bills. It asks for customer, utility account, contact, and bank details, and requires an account selection, signature, date, and a voided check.
Who needs it
Altavista utility customers who want to authorize automatic withdrawals for bills at their service address need to complete and return this application.
How to submit it
Return the signed form with a voided check to the Town of Altavista at 510 7th Street or P. O. Box 420, Altavista, VA 24517.
About notarization
This document is signed without a notary; attach a voided check from a checking account, then sign and date the authorization.
How to submit this form
- 1
Download The Application
Download the Automatic Payment Plan Application Form.
- 2
Complete The Form
Provide customer, utility account, contact, and financial institution details; select checking or savings and sign and date the authorization.
- 3
Attach A Voided Check
Attach a voided check from your checking account, as directed on the form.
- 4
Return The Application
Send the signed form and voided check to the Town at 510 7th Street or P. O. Box 420, Altavista, VA 24517.
Frequently asked questions
- What does the Automatic Payment Plan Application authorize?
- It authorizes the Town of Altavista to withdraw the amount stated on the utility bill from the selected checking or savings account.
- Do I need a notary for the Automatic Payment Plan Application?
- No. Sign and date the authorization without a notary, and attach a voided check from your checking account.
- How do I submit the Automatic Payment Plan Application?
- Return the signed form with a voided check to the Town of Altavista at 510 7th Street or P. O. Box 420, Altavista, VA 24517.