Follow the steps to fill out the form correctly

1. Click ‘Get Form’ button to access the document and open it for editing.
2. Enter your customer name in the designated field. Make sure to provide your full legal name as it appears on your account.
3. Fill in your account number in the next section, ensuring it is accurate to avoid any issues with the automatic draft.
4. Provide your service address. Be thorough and include any necessary details to ensure correct service identification.
5. Input your phone number. This can help the authority contact you if there are any issues with your account.
6. Indicate your customer request by checking the appropriate box: ‘New,’ ‘Change,’ or ‘Cancel.’ This will clarify the action you want to take regarding your bank account draft.
7. In the account information section, fill in the name on the account. This should match the account holder's name at the bank.
8. Next, enter the name of your bank. Ensure it's spelled correctly to prevent any confusion.
9. Fill in your routing number. Double-check this number as it is crucial for processing the transaction.
10. Provide your account number again for verification purposes. This step helps ensure accuracy.
11. Sign and date the form at the bottom once you have completed all required fields. Your signature authorizes the authority to deduct payments from your account.
12. Attach a voided check to the form for verification of your bank account details.
13. Finally, you can either bring the completed form to the Authority office at 5622 Industrial Park Rd., Norton, VA or mail it to P.O. Box 3388, Wise, VA 24293.

Complete your VA Public Service Authority Bank Account Automatic Draft form online today!