Fillable DIRECT DEBIT AUTHORIZATION AGREEMENT City of Woodstock 121 (City of Woodstock)

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DIRECT DEBIT AUTHORIZATION AGREEMENT City of Woodstock 121 (City of Woodstock)

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CITY OF
WOODSTOCK
www.woodstockil.gov
City of Woodstock
121 W. Calhoun Street
Woodstock, IL 60098
WWW.WOODSTOCKIL.GOV
815-338-4300
City Hall Hours
Monday - Friday
8:30AM - 5 PM
Tuesday
8:30 AM - 7 PM
Complete this form to enroll in the Direct Debit
Program. Enclose a voided check or a copy of a
documentation which indicates the account to be
debited.
         ________ Water/Sewer/Refuse    
         ________  Wireless Alarm
I hereby authorize the City of Woodstock and the
financial institution designate to begin deductions
for Direct Debit Program. I understand my
Automatic Payment of the billing amount will be
made each bill due date.
           ____ Checking   ____ Saving
_______________________________________________________
Financial Institution Name
_______________________________________________________
Routing Number  
_______________________________________________________
Account Number
Agreement
This agreement will remain in effect until the City
of Woodstock and the financial institution have
received written notification of termination. If a
Direct Debit payment is returned more than once,
the Cityreserves the right to cancel Direct Debit
_______________________________________________________
Signature                           Date
_______________________________________________________
Name
_______________________________________________________
Address
_______________________________________________________
City                         State   Zip
_______________________________________________________
Utility or Wireless Account Number
DIRECT DEBIT
AUTHORIZATION AGREEMENT
click to sign
signature
click to edit
FREQUENTLY ASKED QUESTIONS
Q. What is the Direct Debit Program?
A. The Direct Debit Program is a convenient, FREE and totally optional service, to make your life
easier by automatically paying your water /sewer / refuse and/or wireless alarm bill from your
checking or savings account. Your payment will be transferred from your checking or savings
account on the day your bill is due.
Q. Do I need a special checking or savings account?
A. No, the City can transfer your payment from almost any checking or savings account in the
United States to pay your bill.
Q. How will I know how much is being paid?
A. The City will continue to send you a water/sewer/refuse/wireless bill and proof of payment
will also appear on your checking or savings account statement.
Q. How will I know if Direct Debit has started?
"Auto Pay" will be on your bill indicating the payment will be made through the Direct Debit.
Your payment will be made on the due date.
Q. What information do I need to set-up my Direct Debit account?
A. Fill out the attached form and return an original signed copy to:
             Direct Debit Program,
             City Hall, 121 W. Calhoun St.,
             Woodstock, IL 60098. 
If you decide to use a checking account, include a copy of a voided check with the form.
If you have a savings account, credit union or money market account, request your Routing
Transit Number (RTN) and account number from the bank.
Q. What if I need to change something that is already set up on my Direct Debit service?
You will need to complete a new direct depositform and return it the address above.
DIRECT DEBIT PROGRAM
TERMS & CONDITIONS
1. Payment can be made from a checking or
savings account from most banks in the
United States.
2. The words “Auto Pay” will be on your
water/sewer/refuse/wirelessbill to notify
you that payment is setup for Direct Debit.
3. If there are insufficient funds in your
account on the specified payment date, the
City of Woodstock reserves the right to take
payment in whole or in part when funds
become available. In addition, a NSF fee will
be assessed on accounts that have
insufficient funds on the scheduled payment
date or if the account is closed.
4. This agreement will remain in effect until
the City of Woodstock is notified in person or
in writing to cancel participation in the Direct
Debit Program. The City requires a15-day
period from the date the notice is received to
remove a participant from the program.
5. Requests to participate in the Direct Debit
Program will not be honored without a
signature on the agreement.
          See back side for the Agreement.
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DIRECT DEBIT AUTHORIZATION AGREEMENT City of Woodstock 121 (City of Woodstock)

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Completed 17 July 2020

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