Blackstone, VA · Nottoway County
Utility Billing Auto Draft Authorization Form
Blackstone utility customers use this form to authorize automatic monthly drafts from a checking or savings account for their utility bill.
What this form is
This form authorizes the Town of Blackstone to debit a customer’s checking or savings account for the full utility bill balance. The form says applications must be received by the 15th of the month to establish drafting for that month’s billing. It asks for customer and utility account details, financial institution and account information, and a signature and date; it also requests a cancelled or voided check or savings deposit slip.
Who needs it
Blackstone utility customers who want their full monthly utility bill drafted automatically from a checking or savings account need 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 document is signed and dated without a notary; include a cancelled or voided check or savings deposit slip as the form requests.
How to submit this form
- 1
Download The Form
Download the Utility Billing Auto Draft Authorization Form.
- 2
Complete The Form
Provide your customer, utility account, financial institution, and account details; select checking or savings, then sign and date.
- 3
Gather The Attachment
Attach a cancelled or voided check or a savings deposit slip.
- 4
Submit To The City
The form says applications must be received by the 15th of the month to establish drafting for that month’s billing.
Frequently asked questions
- Do I need a notary for the Utility Billing Auto Draft Authorization Form?
- No. The form has a signature and date line but no notary block; include a cancelled or voided check or savings deposit slip as requested.
- How do I submit the auto draft authorization form?
- The form does not give application submission instructions. It says applications must be received by the 15th of the month to establish drafting for that month’s billing.
- What account information does the form ask for?
- It asks for financial institution details, a nine-digit routing number, an account number, and whether the account is checking or savings, along with customer and utility account information.
- What attachment should I include?
- The form asks you to attach a cancelled or voided check or a savings deposit slip.
Need something notarized?
This Utility Billing Auto Draft Authorization Form doesn’t need a notary — but if you have another Blackstone form that does, a commissioned online notary can help.