Full Text
CAYUGA COUNTY – DELINQUENT TAX INSTALLMENT AGREEMENTS AUTHORIZATION AGREEMENT FOR ELECTRONIC (ACH) PAYMENTS I (we), the undersigned, hereby authorize the Cayuga County Treasurer’s Office to initiate electronic withdrawals from my (our) bank account indicated below and to credit the same to the account of Cayuga County around the 15th of each month in payment of: Delinquent Tax Installment Agreement – Contract # Amount: Period: to Name (print): Address: City: State: Zip: Phone Financial Institution: City: State: Zip: Account Type: _____Checking _____Savings _____Money Market Routing Number: Account Number: VOIDED CHECK MUST BE ATTACHED! I (we) understand that, should funds not be available in the designated account on the designated due date, it will be the responsibility of the parcel owner to ensure payment in a timely fashion, to avoid further interest or penalties. Returned payments are subject to a $20 fee. Certified funds are required to replace any returns. This authorization is to remain in full force and effect until the completion of the installment agreement or until the Cayuga County Treasurer’s Office receives written notification from me (or either of us) of its termination. Written notification of termination must be received by the Cayuga County Treasurer’s Office at least 10 days prior to the withdrawal date. Additional payments on the installment agreement cannot be made while signed up for electronic ACH payments. I (we) acknowledge that the origination of ACH transactions at my (our) account must comply with the provisions of U.S. law. Account Holder: Signature: Date Account Holder: Signature: Date