Tax Sale Registration and Affidavit or Purchaser with ACH Payment

Name of Representative *

First

Last

Representative's Business Name *

Purchaser’s Name *

First

Last

Purchaser’s Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

(As it will appear on the certificate)

Purchaser’s Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

(As it will appear on the certificate)

Purchaser’s Telephone Number *

Purchaser’s email address *

Purchaser’s Telephone Number for payoffs *

Do you want to set a purchase cap?

Yes
No

What dollar amount?

AGREEMENT FOR ACH PAYMENTS

COMPANY NAME

I (we) hereby authorize Kenton County County Clerk's Office to electronically debit my (our) account(s)). I (we) agree that ACH transactions I (we) authorize comply with all applicable law and the NACHA Operating Rules.

Yes
No

Type of Account (please select one)

Checking
Savings

Routing #

Account #

Depository Name

Name(s) on the Account

Amount of Debit (i.e., flat amount or percentage)

Date(s) and/or Frequency of Credits

Authorization

I(we) understand that this authorization will remain in fullforce and effect until I(we) notify the Kenton County Clerks's Office in writing that I (we) wish to revoke this authorization. I (we) understand that the Kenton County Clerk's Office requires at least 30 days prior notice in order to cancel this authorization.

Name *

First

Last

Date

AGREEMENT FOR ACH PAYMENTS

MAILING ADDRESS

LINKS

Covington

Independence

Voter Registration