Edit, Download, and Sign the Authorization Agreement for Direct Payments
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How do I fill this out?
To fill out this form, start by providing your bank account information. Ensure that all required fields are completed with accurate details. Lastly, remember to sign and date the form before submission.
How to fill out the Authorization Agreement for Direct Payments?
1
Obtain the authorization agreement form.
2
Fill in your bank details including account and routing numbers.
3
Select the type of account: checking or savings.
4
Sign and date the agreement.
5
Submit the form along with any required documents.
Who needs the Authorization Agreement for Direct Payments?
1
New customers of Ellis Water Co. who wish to pay via ACH.
2
Existing customers updating their payment information.
3
Businesses that require direct payment setup for services.
4
Individuals managing multiple payments for household utilities.
5
Customers needing a convenient and automatic payment method.
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Click on the text fields to modify the content.
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Once satisfied, save your changes.
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Download the edited PDF to your device.
What are the instructions for submitting this form?
To submit the authorization agreement, send the signed form to Ellis Water Co. via fax at 812-847-4010 or email your submission to elliswater@minerbroadband.com. You can also mail the form to P.O. Box 291, Linton, IN 47441 for processing. For a smooth operation, ensure that your documents are legibly filled out and complete.
What are the important dates for this form in 2024 and 2025?
Important dates for 2024 include the commencement of ACH debits on the 16th of each month. In 2025, similar scheduling applies unless otherwise notified. Make sure to submit your forms ahead of these dates for uninterrupted service.
What is the purpose of this form?
The Authorization Agreement for Direct Payments is designed to facilitate seamless monetary transactions. It allows customers to set up ACH debits from their checking or savings accounts directly to Ellis Water Co., ensuring timely payment without manual intervention. This process enhances convenience for users looking to automate their monthly utility payments.
Tell me about this form and its components and fields line-by-line.
- 1. Bank Name: Enter the name of your banking institution.
- 2. Account Number: Provide your bank account number for processing payments.
- 3. Routing Number: This is your bank's routing number for ACH transactions.
- 4. Type of Account: Specify whether this is a checking or savings account.
- 5. Printed Name: Write your name as it appears on the bank account.
- 6. Signature: Sign the form to authorize payments.
- 7. Date: Fill in the date you are signing the form.
What happens if I fail to submit this form?
Failing to submit this form may result in the inability to set up ACH debits for your account. Customers risk incurring late fees for delayed payments. It is crucial to adhere to submission deadlines to maintain service continuity.
- Late Payments: Without the form, scheduled payments will not occur.
- Fees Incurred: Customers may face late fees if payments are missed.
- Service Disconnection: Potential disconnection of water services due to non-payment.
How do I know when to use this form?
- 1. New Customer Enrollment: To enable automatic payments for new customers.
- 2. Updating Payment Details: When changing to a different bank account or institution.
- 3. Switching Payment Methods: To switch from manual payments to automated debits.
Frequently Asked Questions
How do I fill out the authorization agreement?
Simply click on the form fields to enter your information, then sign and date it.
What should I include with my application?
A copy of your driver’s license and a voided check or deposit slip.
When will my account be debited?
Your account will be debited on the 16th of each month.
What if my payment is declined?
A return check fee of $30.00 will be applied for insufficient funds.
Can I change my bank account information later?
Yes, you can submit a new authorization agreement with updated details.
What happens if I submit after the 10th?
If received after the 10th, the debit will occur the following month.
Where do I send the form?
Submit the completed form via fax or mail to the designated address.
Is there a processing fee?
No additional fees are charged for setting up direct payments.
Can I cancel the authorization?
Yes, provide written notice to terminate the authorization.
How can I verify my payments?
You can check your bank statements for records of the ACH transactions.
