Home Forms Forms *******Do NOT use Internet Explorer to fill out forms. Please use Chrome, Firefox, Safari, Edge, etc. Name on Service Address Account Service Address(es) Service Address Account Number(s) Phone Number Check and complete only the transaction requested ACH DEBIT -PAYMENT FROM CHECKING ACCOUNT I (we) hereby authorize the CITY OF OCEAN SPRINGS, hereinafter called COMPANY, to initiate debit entires and to initiate, if necessary, credit entries and adjustments for any debit entries in error to my (our) CHECKING account indicated below and the depository named below, hereinafter called BANK, to debit and/or credit the same to such account.Checkbox Field ACH DEBIT - PAYMENT FROM SAVINGS ACCOUNTI (we) hereby authorize the CITY OF OCEAN SPRINGS , hereinafter called COMPANY, to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any debit entries in error to my (our) SAVINGS account indicated below and the depository named below, hereinafter called BANK, to debit and/or credit the same to such account.Complete all informationBank Name AddressCity State Zip Code Transit/ABA # Account # First Name (please print) Last Name (please print) Date ID Number/SSN *THIS PROCESS TAKES TWO BILLING CYCLES TO GO THROUGH.**PLEASE ATTACH A COPY OF A VOIDED CHECK*Digital Signature File Upload - Voided Check Choose File Submit Form
