ACH Auto Pay Sign Up

Customer Authorization for ACH Autopay

Reminder:

If you submit this form between the 16th and the 25th the change WILL NOT be effective for the payment due on the due date. Your ACH payment may still pull from your existing ACH account if one is setup. To prevent this from happening, you will need to make a manual payment by the 20th.

Does this banking information replace current ACH Autopay banking information?*

YesNo

Customer Name*

First NameLast Name

Customer Phone Number*

Area CodePhone Number

Customer Email

example@example.com

Utility Account Street Address*

If there are multiple locations place a comma between each address.

Financial Institution*

Type of Account*

CheckingSavings

Routing Number*

This is always 9 digits

Account Number*

Routing Number: first 9 digits on your check

https://routingnumber.aba.com/

Account Number: digits in between the routing number and the check number

ACH Authorization Agreement

I hereby authorize Spanish Fork City Corp. to initiate automatic withdrawals from my account at the financial institution named below. I understand that payment will be deducted from my account on the due date of each month or the following business day if the due date is on a weekend or holiday.

I understand that I am responsible to pay a returned item fee as specified by the City for any automatic debit that is returned to Spanish Fork City for any reason. In addition, I understand that I will be removed from automatic withdrawals and that a $200 deposit will be required.

Further, I agree not to hold Spanish Fork City Corp. responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in withdrawing funds from my account.

This agreement will remain in effect until Spanish Fork City Corp. receives a written notice of cancellation from me or my financial institution, or until I submit a new/updated ACH Autopay form to Spanish Fork City.

I understand that if I make a payment using another payment method (i.e. in office with cash or check or online with a card) after the 15th of the month, my automatic payment may still be deducted on the due date by Spanish Fork City and I assume responsibility for any bank/credit union fees that may result.

Signature*

Date Signed*