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Horace Utility Bill Auto-Pay Form

  1. Pre-Authorization Debits | ACH

    We are pleased to offer a new way to pay bills – pre-authorized debits. Now you can have your bills paid automatically each month.

  2. On the 25th of each month the amount due on your account will be withdrawn automatically by the financial institution. 1) Partial payments are not acceptable with ACH withdrawals, the full amount on your account is withdrawn. 2) All Residents can sign up.

  3. How does ACH work? The ACH file will be pulled on the 25th of each month, any account signed up with ACH, that has a balance on their account, will have the balance withdrawn.

  4. The authorization form below gives us and your financial institution authority to pay your bill from your account. To take advantage of pre-authorized debits, simply complete the form as follows: 1) Fill in your name, financial institution name and location, and date. 2) Check whether your payment will be withdrawn from your checking or savings account. 3) Attach a voided check for verification of all the financial institution information. If you are unable to attach a voided check, please provide your account number. 4) Sign the form.

  5. Customer name on the bank account

  6. Include branch name if applicable

  7. Account Type*

  8. Bank Routing Number - 9 digit number

  9. Bank Account Number

  10. (e.g. 15th)

  11. I authorize the City of Horace and the financial institution listed below to initiate electronic debit entries and, if necessary, credit entries and adjustments for any debit entries in error to my account on the day of the month specified. This authorization is to remain in force until I terminate it in writing.

  12. Leave This Blank:

  13. This field is not part of the form submission.