Rev. 20170502
DEPARTMENT OF FINANCE
255 Main Street, Room 102, White Plains, NY 10601
TEL: (914) 422-1235 FAX: (914) 422-1273 Email: finrec@whiteplainsny.gov
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS) OF PROPERTY TAX BILLS
I/we hereby authorize The City of White Plains, New York (hereinafter the City") to initiate debit entries to
my/our ___checking ___savings account (select one) indicated below in the financial institution named below,
(hereinafter “Bank”) and to debit the same to such account, for the payment of property tax bills on my/our
property as indicated below on the 15
th
or next business day of each and every January, April and July.
Ban
k Name: _______________________________________________________________________
Ban
k Street: _______________________________________________________________________
Ban
k City: ___________________________________________ State: ____ Zip: ________________
Ban
k Routing Number: ____ ____ ____ ____ ____ ____ ____ ____ ____
Bank Account Number: _______________________________________
This
authorization is to remain in full force and effect until the City has received written notification from me (or
either of us) of its termination in such time and in such manner as to afford the City and Bank reasonable time to
act on such notification. The City, at its sole discretion and at any time, may revoke this direct payments
authorization by written notification to the individual(s) listed below.
Note
: It is the responsibility of the property owner(s) to insure the debit to the above named account has been
made on the 15th of the billing month or next business day as specified above. Should collected funds not be
available in the designated account on the 15th of the billing month or next business day as specified above, no
notice will be given and it will be the responsibility of the property owner(s) to ensure payment in a timely
fashion so as not to incur interest/penalty charges.
Name(s) on the tax bill: ____________________________________________________________________
Property tax ID number: _____________________________________________________
Teleph
one Number(s) _____________________________ _______________________________
E-mai
l Address(es) _____________________________________ _____________________________________
Sign
ature(s): ___________________________________ ______________________________________
____
____________ ________________
Date (MM/DD/YYYY) Date (MM/DD/YYYY)
Please return the completed form to:
Finance Department, City of White Plains, 255 Main St Rm 102, White Plains, NY 10601
or by e-mail to:
finrec@whiteplainsny.gov
Reset Form
Print Form
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome