ACH Payment Setup

We are required to obtain authorization from any individual to debit/credit their personal account, to retain it for our records and to produce it upon request as per the NACHA rules.


I, hereby authorize The Dominion Homeowners Association, Inc., hereinafter called COMPANY, to initiate debit entries (pre-authorized drafts or  withdrawals) and to initiate, if necessary, credit entries and adjustments for credit entries in error to my bank account.

Indicated below at the depository named below, hereafter called DEPOSITORY, to credit and/or debit the same to such account. Please provide a copy of a voided check. If a voided check is not provided, any and all fees associated with the return of a pre-authorized draft or withdrawal will be the responsibility of the account holder.

Please fill out this form below and click submit. If you would like to download a hard-copy instead to print, fill out and drop-off at our office you can get it at ACH Setup.

    Property Address


    Owner Info

    Owner Name


    Owner Home Phone

    Owner Cell Phone


    Bank Information

    Name of Banking Institution

    Routing Number

    Account Number


    Monthly Collection

    Collect ONLY Dominion HOA monthly AssessmentCollect entire account balance monthly (Including transmitters, lot mow & any misc charges, etc.)


    Attach Documents

    If there are any additional documents you need to submit, please upload them here.


    Your Signature

    This authority is to remain in full force and effect until (The Dominion Homeowners Association, Inc.) has received written notification from you (or either of us) of its termination in such time and in such manner as to afford Company and Depository a reasonable opportunity to act on it.