Pay Tax Bill With Electronic Debit Form

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Executive Summary

This document outlines the authorization process for Upper Township residents to pay their property tax bills via direct electronic debit. The form allows for initial authorization or changes to existing account information. Payments will be debited quarterly on the 3rd of February, May, August, and November, or the next business day if the 3rd falls on a weekend or holiday. Applications must be received at least 10 days before the next payment date, and taxes must be current to enroll. The authorization remains active until canceled in writing with 30 days' notice.

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Document Text

--- Document: Pay Tax Bill With Electronic Debit Form Document ---
TOWNSHIP OF UPPER 
AUTHORIZATION OF DIRECT WITHDRAWAL 
Please check the appropriate line; 
______ Initial Authorization 
_______ Change of Account Number or Financial Institute 
PLEASE PRINT 
PROPERTY INFORMATION: 
Block_______ 
Lot_________ 
Qualifier________ 
Property Owner______________________________________________________________ 
Property Location_____________________________________________________________ 
Mailing Address (if different)____________________________________________________ 
Phone Number(s) _____________________________________________________________ 
Email ______________________________________________________________________ 
PREFERRED METHOD OF CONTACT (CHECK ONE OR BOTH) 
Email ___     Text ____ 
BANK INFORMATION 
Bank Name_____________________________________________________________ 
9 Digit Routing Number (located on check)____________________________________ 
Account Number (Checking)___________________(Savings)_____________________ 
You must attach a voided check for the account that you wish to have debited for the purpose of 
verifying the banks routing and account number. 
Name of Account Holder(if not property owner)________________________________ 
AUTHORIZATION 
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. Taxes must be current in order to sign up for this service. 
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: 
Any questions – please call 
Township of Upper PO Box 216 
Tuckahoe  NJ  08250 
(609)628-2804
rsharp@uppertownship.com