You may now pay your GMA Water and/or Sewer bills
electronically.
Your Payment Invoice will indicate "AutoPay: Do Not Pay"
on the stub when activated.
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AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS) |
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Company Name: GETTYSBURG MUNICIPAL AUTHORITY Company Tax ID No: 25-6010768 |
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I, hereby authorize Gettysburg Municipal Authority, hereinafter called COMPANY, to initiate a quarterly debit entry to my account, indicated below, at the depository financial institution named below, hereafter called DEPOSITORY, and to debit the same to such account. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I authorize the company to initiate credit entries to my account if funds are debited from my account in error. Complete your account information Checking Account No:____________________________ OR Savings Account No: ___________________________ Depository
Name: ____________________________________City_____________________State____________Zip_________ Financial Institution’s Routing Number: _______________________________________ This authorization is to remain in full force and effect until Company has received written notification from me of its termination in such time and such manner as to afford Company and Depository a reasonable opportunity to act on it. Customer Name: ________________________________________GMA 5 digit Account No: (on stub)__________________ (Please print) Date: _________________ Phone # _______________________ Signature: ________________________________________ ***** PLEASE ATTACH A VOIDED CHECK *****
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TO BEGIN AUTOMATIC DEBITS FOR YOUR WATER/SEWER BILL:
1) print the form LANDSCAPE FORMAT
2) all information requested on the form is required.
BE SURE TO SIGN THE FORM
3) include a voided check or bank deposit ticket to verify
your information
4) mail form and voided check to:
GMA ACH DEBIT
59 E HIGH STREET
GETTYSBURG PA 17325
Phone:
(717) 334-6738 # 223
(717) 334-6260
(717) 334-1160
E-mail: gm-meterchange@gettysburgma.com