Application for Automatic Water/Sewage Bill Payment via ACH

Overview

This document is an application form for residents to set up automatic payments for their water and sewage bills through the Ebensburg Borough. The system uses ACH (Automated Clearing House) to transfer funds electronically from the customer's bank account.

Instructions for Completion

To receive ACH privileges, applicants must complete the form in its entirety. The process involves providing specific account details and validating bank information.

Required Information

• Service Address: The address where the service is provided (found on the invoice).
• Account Number: The specific account number associated with the utility service (found on the invoice).
• Bank Routing Number: The 9-digit routing number found at the bottom of a check.
• Bank Account Number: The account number found at the bottom of a check (must not exceed 17 digits).

Validation Requirement

Applicants are required to attach an original voided check to the application. This must be placed in the designated area on the form (labeled "Attach voided check to this area") to validate the bank account information.

Authorization

By signing the form, the applicant authorizes Ebensburg Borough to withdraw funds from the listed account for bill payments. A signature and date are required in Section 5 (Approval).

Submission Details

Completed forms should be mailed or faxed to the following address:

Ebensburg Borough Attn: ACH Water Bill 300 West High Street Ebensburg, PA 15931

Fax: 814-472-8789