EB AUTHORIZATION AGREEMENT FOR ACH DIRECT WITHDRAWALS FOR TAX AND WATER AND OR SEWER UTILITY

TOWNSHIP OF EAST BRUNSWICK

1 Civic Center Drive, East Brunswick NJ 08816-1081

AUTHORIZATION AGREEMENT FOR TAX AND/OR WATER / SEWER UTILITY

ACH DIRECT WITHDRAWALS

Complete and Sign the Agreement below.

A current voided check must be scanned and included with this form to confirm your bank routing and account numbers for ACH withdrawals to be made.

Start date for ACH Direct Withdrawals

For Tax payments - submit this form no less than 15 days before the next applicable quarterly tax payment due date of February 1, May 1, August 1, Or November 1.
For Water / Sewer Utility Payments - return this form no less than 15 days before the next due date on the water/sewer bill received.

PROPERTY INFORMATION

Block

Lot

Qualifier (leave blank if none)

Water/Sewer Utility Account #

Owner's Name

Property Address

Mailing Address

City

State

Zip

Phone Number

Email

example@example.com

BANK ACCOUNT INFORMATION

Name of Bank

CheckingSaving

Routing / ABA Number*

Account Number*

Upload a copy of voided check or bank letter*

CLICK TO UPLOAD

DIRECT DEBIT AUTHORIZATION

I hereby authorize the Township of East Brunswick, to debit my checking or savings account to make the payments selected below on the applicable due dates noted:

Select PAYMENTS to be made via ACH.

ONLY TAX paymentsONLY WATER / SEWER Utility paymentsBOTH TAX & UTILITY

I understand that these charges will be deducted automatically until I make a written request to the Township of East Brunswick to discontinue direct debit from my account or email a request to Tax@eastbrunswick.org. I shall notify the Township of East Brunswick IMMEDIATELY if I am selling my property or no longer wish to participate in the ACH Plan.

I understand funds must be available two days prior to the due date and agree that all insufficient funds will incur a $20 returned check fee.

Print Name*

Signature*

Date*

Date

The Township of East Brunswick assures you that no personal identifying information that is supplied by you on this form will be disclosed, as personal information is deemed confidential pursuant to the Open Public Records Act, N.J.S.A. 47:1A-1, et seq.

We are here to help you! Questions can be emailed to TAX@EastBrunswick.org or you can call 732-390-3259.

East Brunswick Township is an Equal Opportunity Employer.