AUTHORIZATION AGREEMENT FOR
DIRECT PAYMENTS (ACH DEBITS)
Name: ___________________________________________________________________
Property Location: ________________________________________________________
Mailing Address (if different): ______________________________________________
Phone Number: ___________________________________________________________
Email address: ____________________________________________________________
____ Please pay my taxes by ACH Debit on the due dates of August 15, November 15 and February 15 or the
next business day if the due date falls on a weekend or holiday.
Tax Parcel ID #: _____________________________________________________
____ Please pay my water/sewer/stormwater bill by direct debit on the due dates of March 31, June 30,
September 30 and December 31 or the next business day if the due date falls on a weekend or holiday.
Water/Sewer/SW Account #: _______________________________________________
I would prefer to have my Water/Sewer/SW bill: [ ] emailed or [ ] mailed.
I hereby authorize the Town of Williston to initiate debit entries to my bank account below for the full
amount due on the dates stated above. If the date falls on a holiday or weekend, the transaction will occur on
the following business day.
This written authority is to remain in full force and effect until a written notice from me is provided to the
Treasurer to terminate this agreement or the Town terminates this agreement due to a lack of funds or
delinquent account status. I will contact the Treasurer’s office if I sell or transfer the property, or if I change
my bank account from which this payment will be taken.
Bank or Credit Union Name: _______________________________________________________
Routing # ______________________________________ [ ] Checking or [ ] Savings
Account # ______________________________________ [ ] Personal or [ ] Commercial
Please attach a voided check with this request if using a checking account.
Signed: _________________________________________________ Date:__________________
Return or mail original to: Williston Town Treasurer, 7900 Williston Road, Williston, VT 05495
Rev. 8.29.25