Do I need a notary for the ACH authorization form?

No. Sign and date the form without a notary. Attach a voided check for a checking account or a voided deposit slip for a savings account.

How do I submit the ACH authorization form?

Return it to Town of Berryville at 101 Chalmers Ct, Ste. A, Berryville, VA 22611, or email customerservice@berryvilleva.gov by the 25th of the month.

What bank information does the form ask for?

The form asks for the depository bank name, branch, city, state, ZIP code, routing number, account number, and whether the account is checking or savings.

When are automatic utility payments made?

The form says payments are debited on the 15th of each month. If the 15th falls on a weekend or holiday, payment is made the next business day.

Berryville, VA · Clarke County

No notary required

ACH Letter and Authorization Form

Berryville utility customers use this form to authorize automatic monthly water or sewer bill payments from a checking or savings account.

What this form is

This form authorizes the Town of Berryville to debit utility payments from a designated checking or savings account through ACH. Customers complete it to enroll in automatic payments and provide their utility account, service address, bank, and account details. The form asks for a voided check for checking accounts or a voided deposit slip for savings accounts, along with account-owner signatures and the date.

Who needs it

Berryville water or sewer customers who want their utility bill automatically debited from a checking or savings account should complete this form.

How to submit it

Return the form to Town of Berryville, 101 Chalmers Ct, Ste. A, Berryville, VA 22611, or email it to [email protected] by the 25th of the month.

About notarization

This form is signed and dated without a notary; attach a voided check for checking or a voided deposit slip for savings.

How to submit this form

1
Download The Form
Download the ACH Letter and Authorization Form PDF.
2
Complete The Form
Enter your utility account and service details, bank information, account type, and account-owner information.
3
Gather The Attachment
Attach a voided check for a checking account or a voided deposit slip for a savings account.
4
Sign And Submit
Sign and date the form, then return it to the Town by mail or email by the 25th of the month.

Frequently asked questions

Do I need a notary for the ACH authorization form?: No. Sign and date the form without a notary. Attach a voided check for a checking account or a voided deposit slip for a savings account.
How do I submit the ACH authorization form?: Return it to Town of Berryville at 101 Chalmers Ct, Ste. A, Berryville, VA 22611, or email [email protected] by the 25th of the month.
What bank information does the form ask for?: The form asks for the depository bank name, branch, city, state, ZIP code, routing number, account number, and whether the account is checking or savings.
When are automatic utility payments made?: The form says payments are debited on the 15th of each month. If the 15th falls on a weekend or holiday, payment is made the next business day.

Need something notarized?

This ACH Letter and Authorization Form doesn’t need a notary — but if you have another Berryville form that does, a commissioned online notary can help.