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I
authorize Appalachian Electric Cooperative to debit
my bank account monthly by Automated Clearing House
for the payment of my electric bill due to Appalachian
Electric Cooperative.
I
further agree that you shall be under no obligation
to furnish me with any special advice or notice in writing
or otherwise of the charging of same to my account.
This
authorization is to remain in effect until revoked by
me in writing. Until you actually receive such notice,
I agree you shall be fully protected in honoring any
such electric debit to my account.
NOTE
TO BANK: If the information on the card does not agree
with your records, or if the arrangement is not in keeping
with your procedures, please contact
Appalachian Electric Cooperative, P.O. Box 710, Jefferson
City, TN 37760.
Telephone: 865-475-2032 Ext.1107
Appalachian
Electric Cooperative
Authorization Form for FREE Automatic Clearing House
(ACH)
(Please
Print)__________________________________________________________
Your Name as Shown on Bank Records
______________________________________________________________________
Checking Account Number
______________________________________________________________________
Name of Bank and Branch, if any
______________________________________________________________________
Street Address of Bank
__________________________________________________________
City or Town
I
hereby authorize my electric bill to be paid by my Bank:
________________________________
Depositors Signature
________________
Phone Number |
______________
Date |
_______________
AEC Account# |
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