TOWNSHIP OF
UPPER
AUTHORIZATION
OF ELCTRONIC PAYMENTS
Please check the
appropriate line;
______ Initial
Authorization _______
Change of Account Number or Financial Institute
PROPERTY
INFORMATION:
Block_______
Lot_________
Qualifier________
Property
Owner______________________________________________________________
Property
Location_____________________________________________________________
Mailing Address (if
different)____________________________________________________
Phone Number(s)
_____________________________________________________________
Email
______________________________________________________________________
Bank
Name_____________________________________________________________
9 Digit Routing Number (located on
check)____________________________________
Account Number
(Checking)___________________(Savings)_____________________
Name of Account Holder(if not property
owner)________________________________
I authorize the
Township of Upper to debit the account-identified quarterly for Property Taxes.
Payments will be
debited from the account on the 3rd of the month that taxes are due
(February,
May, August, and
November). If the 3rd
day occurs on a weekend or holiday the payment will
be effective the
next business day. Applications
must be received at least 10 days prior to the date of the next payment.
Please attach a
voided check on the account that you wish to have debited for the purpose of
verifying the banks routing and account number.
This authorization
shall remain in full force until I cancel it in writing by sending my
notice at least 30 days prior to the date of next scheduled debit.
________________
_______________________________________________
Date
Signature of Account Holder
Mail completed form
& attachment to:
Township of Upper
PO Box 216
Tuckahoe NJ
08250
Any questions –
please call
(609)628-2011 x 260