ACH-Direct Payment Authorization Agreement
I hereby authorize Mapleton City Corp. to initiate automatic withdrawals from my account at the financial institution named above. I understand that payment will be deducted from my account on the 20th of each month or the following business day if the 20th is on a weekend or holiday.
I understand that I am responsible to pay a returned item fee of $20 as specified by the City for any automatic debit that is returned to Mapleton City for any reason. In addition, I understand that I will be removed from automatic withdrawals and that a $150 deposit will be required.
Further, I agree not to hold Mapleton City Corp. responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in withdrawing funds from my account.
This agreement will remain in effect until Mapleton City Corp. receives a written notice of cancellation from me or my financial institution, or until I submit a new/updated ACH-Direct Pay form to Mapleton City.
I understand that if I make a payment using another payment method (i.e. in office with cash or check or online with a card) after the 15th of the month, my automatic payment may still be deducted on the 20th by Mapleton City and I assume responsibility for any bank/credit union fees that may result.