Auto-Draft Credit Card Form

Credit Card Auto-Draft Form

Name on Member Account

Member Account Number(s)

Member Account Number 2

Member Account Number 3

Credit Card Type

Visa

Mastercard

Discover

American Express

Credit Card Number

Credit Card Number - AMEX

Expiration Date

Security Code

Name On Card

Phone

Billing Address of Card

Address 2

City/Town

State/Province

ZIP/Postal Code

I agree to the terms of service.

Terms

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

Signature

Sign above

Date

OUTAGE REPORTING: 903.583.2117 | 1.800.695.9020