This program is only available to taxpayers who are not currently escrowing their property tax and is
only for the current year taxes. Form A 10/2020
No. of payments:_____
Installment Amt:$______
I authorize Hamilton County Trustee’s Office to draft my account specified below for payment of
property taxes for the following map parcel number:________________________________________
You are authorizing Hamilton County Trustee’s Office to debit your checking/savings account through ACH
beginning on (check one) November 5th or December 5
for the installment amount listed below. Your
account will be debited on the 5
of each month with February 5
, 2021, being the last payment. If this date
falls on a weekend, your account would be debited on the next business day. To cancel the automatic draft or
make changes we must be notified in writing 30 days prior to the withdrawal date. Signing this form verifies
you understand that failure to have sufficient funds on the day of the debit or failure to notify Hamilton County
Trustee’s Office of a bank or account change will result in a $30 NSF fee and removal from the program. The
deadline for signing up for automatic bank draft is November 20
, 2020.
For more information contact Hamilton County Trustee’s Office at 423-209-7270 or visit our website
Return completed original form (*with required attachments) in person or by mail to:
Hamilton County Trustee’s Office
625 Georgia Avenue, Suite 210
Chattanooga, TN 37402
All information must be completed
Owner’s Name:____________________________________________________________________________________
Mailing Address:____________________________________ Phone:_______________________________________
____________________________________ Email:_______________________________________
Property Address:________________________________________________________________________
Bank Information
Name(s) on Bank Account:_______________________________________________________________
Bank Name:_________________________________________________________
Bank Address________________________________________________________
Checking (a voided check [not a deposit ticket] is Savings (documentation from your bank is
required to verify the routing and account number) * required to verify the routing and account number) *
Routing Number Account Number
___________________________ _____________
Signature Date
For Office Use Only
Clerk Initials:___________
Only check one box:
City, State, Sip
(Map# from tax bill)
click to sign
click to edit