Follow the steps to complete your agreement online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your name in the designated field at the top of the form. This should be the name associated with your bank account used for payment.
3. Fill in your account number, which is the bank account you will be using for the automatic payments.
4. Provide your mailing address, ensuring you include your city, state, and ZIP code for accurate communication.
5. Enter your case number if applicable. This helps identify your records with Placer County Revenue Services.
6. Input your email address. By providing this, you agree to receive all notices electronically, which helps keep you informed.
7. Fill in the monthly debit amount you wish to authorize for automatic payments. Ensure this amount is correct to avoid any transaction issues.
8. Select the monthly debit date. This is the specific date each month when your payment will be automatically withdrawn.
9. Attach a voided check or documentation provided by your bank that indicates your account and routing number. Ensure this is securely attached to the form.
10. Sign and date the form at the bottom. Your signature indicates your authorization for the automatic debit.
11. Once you have filled out and signed the form, you can fax it to the number provided, 916-543-3910, or email it to REVSERV@placer.ca.gov. Ensure you keep a copy for your records.

Start filling out your CA Automatic Recurring Payment Agreement online today!