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Auto Bank-Draft Form

Auto Bank-Draft Form

Member Name

Member Account Number(s)

Member Account Number 2

Member Account Number 3

Name Of Financial Institution

Routing Number

Bank Account Number

Bank Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Account Type

Checking

Savings

Name On Account

Email

Phone

Mailing Address

Address 2

City/Town

State/Province

ZIP/Postal Code

I agree to the terms of service.

Terms of Service

I authorize Fannin County Electric Cooperative, INC. to draft the amount due on my account each billing cycle from the bank account information entered on this form. This shall continue each billing cycle until I provide sufficient notice of cancellation.

Signature

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