DIRECT DEBIT PAYMENT AUTHORIZATION FORM

Document Overview

This is a Direct Debit Payment Authorization Form issued by the Williamsburg Municipal Authority (WMA). It allows residents to authorize automatic withdrawals from their bank accounts for payments.

Key Details

• Organization: Williamsburg Municipal Authority
• Tax ID#: 25-1201030

Instructions for Completion

To use this form, the customer must provide the following information:

• Account Type: Select either Checking or Savings.
• Bank Information: Name of the bank, branch location, city, state, zip code, routing number, and account number.
• Customer Information: Full name and Social Security Number (SSN).
• Authorization: Signature and date.

Important Notes & Requirements

• Voided Check: A voided check must be attached to the bottom of this form.
• Termination: The authorization remains in effect until written notification is received by the WMA.
• Revocation: To cancel this authorization, you must notify the WMA in writing no later than 15 days before the next transaction effective date.
• Bank Verification: There is an optional section for a bank representative to verify the account details.