ACH Authorization Form

Authorization Agreement for Preauthorized Electronic Withdrawals

The ACH automatic withdrawal payment option is a free, convenient, hands-free way to ensure you never miss a payment. The same amount is withdrawn from your checking or savings account on the last business day of each month. 

Please complete the ACH Authorization and mail or drop in our box at the City Market Customer Service counter. You can also email to Tara Espinoza:




ONLINE Electronic versions of all BVSD forms can now be filled out and submitted online.

PRINT You can also download a printable version of each form to print on your own computer.

PICK UP You can pick up a copy of any form at our office.



SUBMIT the online version of each form instantly

MAIL printed forms to PO Box 3069, Buena Vista, CO 81211

EMAIL a scanned copy of printed forms to

FAX printed forms to 719-395-5859

DROP OFF completed forms at our office

DROP BOX We have a drop box for completed forms and payments at City Market near the Customer Service desk, which is checked each work day.

Contact Us

26200 CR 301
PO Box 3069
Buena Vista, CO 81211