Direct Payment Authorization Agreement
City of Akeley Utility ACH
I (we) hereby authorize City of Akeley, hereinafter called COMPANY, to initiate debit entries to my (our) account indicated below and the financial institution named below, hereinafter called DEPOSITORY, to debit the same to such account. I (we), also authorize COMPANY to initiate credit entries to my (our) account indicated below and the DEPOSITORY to reverse any debits made to such account in error. This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
I am not currently participating in the Direct Payment Program
I am currently participating in the Direct Payment Program
Due to the time required for COMPANY and bank processing, allow one month for processing.
**IMPORTANT** CHECK TYPE OF ACCOUNT: [ ] CHECKING [ ] SAVINGS
TAPE YOUR VOIDED CHECK HERE