Automatic Bank Draft Program

Automatic Bank Draft Program Print This Page

A convenient way to pay your utility bill. This option is available to
anyone who wishes to take advantage of the service. Your monthly payment
is automatically paid by your bank account every month.

Plateau Electric Account Number: ______________

Name: ________________________________

Billing Address: __________________________________________________

City: ________________ State ______ Zip: ______________

Phone: _________________________

Preauthorization Form

I (we) hereby authorize Plateau Electric Cooperative and Automated Payment
Systems, Inc. acting on behalf of Plateau Electric Cooperative to initiate
debit entries to such account by funds transfer for payment of my monthly
utility bill.

This authority is to remain in full effect until I notify Plateau Electric
Cooperative that I wish to end this agreement and Plateau Electric
Cooperative has had reasonable time to act on it; or until Plateau Electric
Cooperative has sent me 10 days written notice that they will end this
agreement.

I understand that Plateau Electric Cooperative will continue to send me a
bill and that there will be a minimum of 15 days after the date of billing
to notify Plateau Electric Cooperative of any error on the bill.
I further understand that in the event my account has insufficient funds
to cover the monthly payment amount drafted, or my monthly draft rejects
due to account closed status, bank ownership changes or account changes, a
$25 fee will be assessed and debited from my account in addition to the
monthly payment due. It is my duty to notify Plateau Electric Cooperative
15 days prior to a scheduled debit of any changes made to my designated
depository account, including but not limited to closed status, bank
ownership changes and account changes.

I attest I am an authorized owner of the Depository Account listed below,
and am exercising my powers as such.

_____________________________________ _______________
Authorized Signature Date

_______________________________________
Depository Account to be Drafted

Please Attach a Voided Check

I understand that I must complete the attached form and sign the
"Preauthorization Form." Both forms, along with a voided check, can be
mailed to: Plateau Electric, P.O. Box 4669, Oneida, TN 37841.

Forms and check must be received at least 15 days prior to your next bill
date in order to draft your upcoming electric bill.

Send this form with your current monthly payment, to be assured next
month's bill will be drafted.

_____________________________________________________________________________
To be completed by Plateau Electric

Control #: _____________________________________

Date: ________________________________