Vancouver, WA · Clark County
ACH Debit Authorization Form
City of Vancouver customers complete this form to authorize automatic monthly payments by debit from a bank account.
What this form is
This form authorizes the City of Vancouver to withdraw monthly payments from the customer’s bank account on or about the 25th of each month. Customers starting Auto Pay provide bank, account, contact, and signature details, and attach a voided check showing the routing number for payments.
Who needs it
City of Vancouver customers who want monthly payments automatically withdrawn from their bank account use this form to start Auto Pay.
How to submit it
Return the completed form and a copy of a voided check to the City of Vancouver Accounts Receivable Department, P.O. Box 8995, Vancouver, WA 98668-8995.
About notarization
This form is signed and dated without a notary; attach a voided check showing the account routing number, and the signer just signs and dates the form.
How to submit this form
- 1
Download The Form
Download the City of Vancouver ACH Debit Authorization Form.
- 2
Complete The Form
Enter your financial institution and account details, customer account number, contact information, and signature.
- 3
Gather The Attachment
Attach a copy of a voided check showing the account routing number for your payments.
- 4
Submit To The City
Return the form and voided check to the Accounts Receivable Department at the mailing address printed on the form.
Frequently asked questions
- What does the ACH Debit Authorization Form do?
- It authorizes the City of Vancouver to debit monthly payments from the bank account you identify, with withdrawals made on or about the 25th of each month.
- What should I attach to the form?
- Attach a copy of a voided check that shows the account routing number you want to use for payments.
- How do I submit the ACH Debit Authorization Form?
- Return the completed form and a copy of your voided check to the City of Vancouver Accounts Receivable Department at P.O. Box 8995, Vancouver, WA 98668-8995.
- Do I need a notary for the ACH Debit Authorization Form?
- No. Sign and date the form without a notary, and attach the requested voided check showing your account routing number.