What does the White Salmon ACH authorization agreement do?

It authorizes the City of White Salmon to initiate debit entries from the financial institution account identified on the form.

What should I attach to the ACH authorization?

Attach a voided check with the application for verification. The form asks for utility-account details and financial institution and account information.

White Salmon, WA · Klickitat County

No notary required

Authorization Agreement for Direct Payments (ACH Debits)

White Salmon utility customers use this agreement to authorize ACH debit payments from a checking or savings account and provide account details.

What this form is

This agreement lets a White Salmon utility customer authorize the city to debit payments from a checking or savings account. Complete it to set up ACH withdrawals, providing utility-account and financial-institution details, then attach a voided check for verification. The second page includes a separate section for revoking an ACH withdrawal, with fields for the original applicant signature and city use.

Who needs it

White Salmon utility customers who want to authorize ACH debits from a checking or savings account need to complete 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 document is signed without a notary; attach a voided check for verification, and the applicant signs the authorization.

How to submit this form

1
Download The Agreement
Download the White Salmon Authorization Agreement for Direct Payments (ACH Debits).
2
Complete The Form
Enter your utility account and financial institution information, then sign the authorization.
3
Gather The Attachment
Attach a voided check for verification.
4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.

Frequently asked questions

What does the White Salmon ACH authorization agreement do?: It authorizes the City of White Salmon to initiate debit entries from the financial institution account identified on the form.
What should I attach to the ACH authorization?: Attach a voided check with the application for verification. The form asks for utility-account details and financial institution and account information.
Do I need a notary for the ACH authorization agreement?: No. This document is signed without a notary. Attach a voided check for verification, and sign the authorization.
How do I submit the ACH authorization agreement?: Submit it to the city department named on the form; check the city website for current contact details.

Need something notarized?

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