ACH Authorization Agreement

Set up recurring monthly utility payments using your checking or savings account.

Before completing the form, you will review the ACH authorization information and confirm that you understand the purpose of this agreement.

Please have your banking information and your Utility Billing Solutions account information available for this form. A picture of a voided check, or screenshot of your banking app showing routing and account number, is required. These are used to confirm the banking information as provided on the form.

Authorization Information

Please review the ACH authorization information below before continuing to the form.

Company Name: Utility Billing Solutions, LLC

Company ID Number: 3458

I/we hereby authorize Utility Billing Solutions, LLC, hereinafter called COMPANY, to initiate debit entries to my/our Checking Account/Savings Account indicated below at the depository financial institution named below, hereinafter called DEPOSITORY, and to debit the same to such account. I/we acknowledge that the origination of ACH transactions to my/our account must comply with the provisions of U.S. law.

I have reviewed and agree to the ACH authorization information above.

Please check the agreement box before continuing.

Bank Account Information

Please complete the information below to authorize recurring monthly utility payments.
* Required fields.

Your Depository Branch *

Account Type *
Checking AccountSavings Account

Your Name *

Your Email *

City *

State *

Zip *

Routing Number *

Account Number *

Names *

Phone Number *

Date Signed *

Signature *

Utility Billing Solutions Account Information

Please provide the UBS account details associated with your utility service.

Service Address *

Name On The Account *

6 or 7 Digit Account Number *

Please upload a picture of a voided check or screenshot of your bank app. *

Accepted file types: JPG, JPEG, or PNG. Maximum file size: 24MB.

By completing this form, you understand and agree to the following:

You authorize Utility Billing Solutions, LLC to initiate recurring monthly debit entries to the checking or savings account provided on this form.
The origination of ACH transactions to your account must comply with the provisions of U.S. law.
All payments will take place on the 10th of each month.
If payment is returned due to incorrect account information, incorrect routing information, or insufficient funds, there may be a $35.00 fee.
You will continue receiving monthly statements showing the amount of the payment to be drafted.
This authorization will remain active until Utility Billing Solutions receives written notice of cancellation with at least 30 days to process the request. To stop payments, email customerservice@utbilling.com.