Town of Woodbury
P0 Box 10
Woodbury, VT 05681
802-456-7051
Fax 802-456-8834
Direct Debit Authorization Agreement
To enroll in the direct debit program submit this completed agreement to the Treasurer’s Office at least fifteen
(15) days prior to a payment due date with an attached voided check. This program is available ONLY through
US banks.
I authorize the Town of Woodbury to debit my bank account listed below in the exact amount of my property
tax payment on the due date.
Property Owner Last Name Parcel I134h
Bank Holder Name:
Bank Name: 0 Checking 0 Savings
Bank Account #: #:___________________
Email: Phone:
I hereby acknowledge that I have signature authority on the above listed bank account and agree that sufficient
funds will be available in said account on the due dates to permit payment of the above property tax account. I
understand that failure to maintain sufficient funds in the above listed bank account will result in the Town
assessing interest and delinquent penalty fees on any overdue balance at rates stated on the annual property tax
bill. I also understand that it is my responsibility to notify the Town at least fifteen (15) days prior to the
payment due date if there is a change to my bank account.
If you currently have this agreement on file in the Treasurer’s office you do not need to resubmit it each year. I
further agree that this direct debit authorization will remain in effect indefinitely, unless and until I provide at
least fifteen (15) days written notice of its cancellation to the Treasurer’s Office.
Signature:
P0 Box 10
Woodbury, VT 05681
802-456-7051
Fax 802-456-8834
Direct Debit Authorization Agreement
To enroll in the direct debit program submit this completed agreement to the Treasurer’s Office at least fifteen
(15) days prior to a payment due date with an attached voided check. This program is available ONLY through
US banks.
I authorize the Town of Woodbury to debit my bank account listed below in the exact amount of my property
tax payment on the due date.
Property Owner Last Name Parcel I134h
Bank Holder Name:
Bank Name: 0 Checking 0 Savings
Bank Account #: #:___________________
Email: Phone:
I hereby acknowledge that I have signature authority on the above listed bank account and agree that sufficient
funds will be available in said account on the due dates to permit payment of the above property tax account. I
understand that failure to maintain sufficient funds in the above listed bank account will result in the Town
assessing interest and delinquent penalty fees on any overdue balance at rates stated on the annual property tax
bill. I also understand that it is my responsibility to notify the Town at least fifteen (15) days prior to the
payment due date if there is a change to my bank account.
If you currently have this agreement on file in the Treasurer’s office you do not need to resubmit it each year. I
further agree that this direct debit authorization will remain in effect indefinitely, unless and until I provide at
least fifteen (15) days written notice of its cancellation to the Treasurer’s Office.
Signature:
Date:
O New Application 0 Update By:__________________
Received: Processed: – — Effective: