What does the Utility Payment Authorization Agreement do?

It authorizes the Town of Mineral to debit a checking or savings account electronically for utility bill payments and provides account and contact information.

When are utility payments debited?

The agreement says debits occur on the 15th of each month, with the date adjusted when the 15th falls on a Saturday, Sunday, or holiday.

Do I need a notary for the Utility Payment Authorization Agreement?

No. This agreement is signed and dated without a notary, and it identifies no notarized or sworn attachment.

Mineral, VA · Louisa County

No notary required

Utility Payment Authorization Agreement – Direct Payments (ACH Debits)

This agreement lets a Town of Mineral utility customer authorize monthly electronic debits from a checking or savings account to pay utility bills.

What this form is

A Town of Mineral utility customer uses this agreement to authorize electronic debits from a checking or savings account for utility bill payments. It specifies that debits occur on the 15th of each month, with adjustments when that date falls on a weekend or holiday. The agreement requests bank and utility account details, contact information, and the account holder’s printed name, signature, and date.

Who needs it

A Town of Mineral utility customer who wants to authorize monthly utility bill payments by electronic debit from a checking or savings account needs this agreement.

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 agreement is signed and dated without a notary; it identifies no notarized or sworn attachment, so the signer just signs and dates it.

How to submit this form

1
Download The Agreement
Download the Utility Payment Authorization Agreement PDF.
2
Complete The Agreement
Enter the bank and utility account details, contact information, printed name, signature, and date.
3
Gather Attachments
The document does not identify any required attachments.
4
Submit To The Town
Submit it to the city department named on the form; check the city website for current contact details.

Frequently asked questions

What does the Utility Payment Authorization Agreement do?: It authorizes the Town of Mineral to debit a checking or savings account electronically for utility bill payments and provides account and contact information.
When are utility payments debited?: The agreement says debits occur on the 15th of each month, with the date adjusted when the 15th falls on a Saturday, Sunday, or holiday.
Do I need a notary for the Utility Payment Authorization Agreement?: No. This agreement is signed and dated without a notary, and it identifies no notarized or sworn attachment.
How do I submit the Utility Payment Authorization Agreement?: Submit it to the city department named on the form; check the city website for current contact details.

Need something notarized?

This Utility Payment Authorization Agreement – Direct Payments (ACH Debits) doesn’t need a notary — but if you have another Mineral form that does, a commissioned online notary can help.