Modify / Cancel Lucas County TIPP, ACHM or ACH2 Agreement
I herewith give notice to the Lucas County Treasurer's Office that
*
I wish to change my bank account information and am attaching a new voided check or bank account information.
I wish to cancel the TIPP (monthly vouchers) agreement
I wish to cancel the automatic withdrawals and the ACHM or ACH2 agreement.
Name
*
First Name
Last Name
E-mail
*
Phone Number
*
Format: 000-000-0000.
Your Mailing Address
*
Street Address
City
State
Zip Code
The changes or cancelation apply to the following Parcel Number(s)
*
Upload a voided check or savings account statement. The document must be issued by your financial institution. Hand-written instructions will not be accepted.
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
What type of bank account is this?
*
Checking
Savings
Signature
*
Submit
Should be Empty: