DIRECT DEBIT AUTHORIZATION
DIRECT DEBIT AUTHORIZATIONThis form is used for direct debit of your account. Each customer must complete and sign the authorizations form.AUTHORIZATION AGREEMENT FOR AUTOMATIC DIRECT DEBIT (ACH DEBIT)Trumbull County Water and Sewer Accounting DepartmentI hereby authorize The Trumbull County Water and Sewer Accounting Department to initiate debits entries to my (our) account listed below:012890500FINANCIAL INSTITUTION NAMETRANSIT/ABA NO.ACCOUNT NO.TYPE OF ACCOUNTPlease choose oneChecking - SavingsLOCATION (BRANCH)MAX DEBIT ALLOWEDThe authority is to remain in full force until Trumbull County Water/Sewer Accounting Department has received written notification from me of its termination in such timely manner as to afford Trumbull County Water/Sewer Accounting Department and FINANCIAL INSTITUTION a reasonable opportunity to act on it.Insufficient Funds in the account will result in a $25.00 additional fee.NAME ON ACCOUNTWATER/SEWER ACCOUNT NUMBERSERVICE ADDRESSTODAY’S DATESIGNATURE________________________________________________________*Transit No. is the nine digit number that appears on the bottom of a check or deposit slip.PLEASE ATTACH A VOIDED CHECK TO THIS FORM ................
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