ACH Authorization Agreement

CITY OF LOWELL
AUTHORIZATION AGREEMENT
ACH PREAUTHORIZATION PAYMENTS (DEBITS)

NOTE: You will need to complete all steps before the ACH process can start. All steps must be completed by the 10th of the month that you want the ACH to start.
Begin

Online Steps

1

Applicant Full Name

2

Applicant Phone Number

3

Applicant Email Address

4

Lowell Utility Account #

5

Financial Institution Name, City, and State

6

Checking or Savings

Please enter "Checking" for a checking account or "Savings" for a savings account.
7

Bank Transit/Routing Number

8

Bank Account Number

9

ACH Authorization Requirements

By entering "YES" below, you agree to the following terms:

I understand that this authorization will be effective until I complete and return a Voluntary Termination of ACH Draft form at City Hall stating that I no longer desire this service, also allowing reasonable time for the City of Lowell to act on my notification. I also understand that if corrections in the debit amount are necessary, it may involve an adjustment (credit or debit) to my utility account only. No checks are issued at the counter at City Hall.

I understand my drafts will not end until my final bill has been processed if I am closing out my current water account with the City of Lowell.

I understand my draft account is controlled by the consumption or amount of water that I use monthly. The draft amount will not necessarily be the same each month due to either more water used or a potential rate increase. Also, if a leak goes unnoticed by me and the City of Lowell prior to the draft, I understand that the City of Lowell is not responsible for an overdraft on my account or penalties incurred by my financial institution. During the next month's billing cycle any potential credit will be placed back on my account after I have met all leak adjustment requirements.

I understand if my draft utility payment is returned as unpaid, then I will be charged a returned item fee and will be responsible for the full amount of my utility bill plus the returned item fee within ten days in order to not have my service interrupted.
10

****YOUR ACCOUNT WILL BE DRAFTED BETWEEN THE 12TH AND 17TH OF EVERY MONTH****

By entering your name and today's date below, you agree to the following:

I hereby authorize the CITY OF LOWELL to initiate debit entries or such adjusting entries, either debit or credit, which are necessary for corrections, to my checking or savings account indicated above and the financial institution named above to credit (or debit) the same to such account.
11

Upload Voided Check or Bank Letter

12

City of Lowell to Initiate ACH Draft

Until this step is marked complete by the Lowell staff, your application is not complete. This is only a confirmation that you have submitted the steps for review by Lowell staff. You may receive an email from our team if certain information is filled out incorrectly.

If we have any questions, we will contact you. You can call (704) 824-3518 and select option 1 to inquire on your application.