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ACH Stop Payment Form

2. 

4. Date:
   Date:

6. Account Number:

8. First Name

9. Last Name

11. Address

13. City

14. State

15. Zip Code

17. By electronically signing and submitting this form, I hereby authorize the City of Zanesville to stop ACH payments to the financial institution that I had indicated previously for the purpose of paying my monthly utility bill with the City of Zanesville. I have read and agree to the terms and conditions outlined.

    By electronically signing and submitting this form, I hereby authorize the City of Zanesville to stop ACH payments to the financial institution that I had indicated previously for the purpose of paying my monthly utility bill with the City of Zanesville. I have read and agree to the terms and conditions outlined.

19. Signature

20. Date
    Date

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

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