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Howell-Oregon Electric Cooperative - Credit/Debit Authorization Form
I(We) hereby authorize
HOWELL-OREGON ELECTRIC COOP., INC. to initiate entries to my(our)
checking/savings account at the financial institution listed below
(THE FINANCIAL INSTITUTION), and, if necessary, initiate adjustments
for any transactions credited/debited in error. I(We)
understand that the amount of the transaction initiated in my account
may vary from month to month. This authority will remain in
effect until HOWELL-OREGON ELECTRIC COOP., INC., is notified by
me(us) in writing to cancel it in such time as to afford
HOWELL-OREGON ELECTRIC COOP., INC., and THE FINANCIAL INSTITUTION a
reasonable opportunity to act on it.
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______________________________________________
(Name
- PLEASE PRINT)
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_________________________________
(Phone
Number)
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________________________________________________________________________
(Address - PLEASE PRINT)
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The Financial
Institution
____________________________________________________________________________
(Name of Financial Institution)
____________________________________________________________________________
(Adress of Financial Institution-Branch, City,
State & Zip)
Financial Institution Routing
Number:_______________________________________________________
(A nine (9) digit number, usually on the botton
left of your check)
Checking Account number :___________________OR
Savings Account Number:_______________
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Please Pay the Following Electric
Accounts by ACH Debit from the above listed Financial Institution:
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1____________
(Account Number)
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___________________
(Name on Electric
Account)
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3.___________________
(Account Number)
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_______________________
(Name on Electric
Account)
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2.______________
(Account
Number)
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______________________
(Name
on Electric Account)
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4.___________________
(Account Number)
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_______________________
(Name on Electric
Account)
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I(We) understand and agree
that my(our) bank account will be debited on or near the 10th of
every month, once it is activated, and the amount of the debit may
vary from month to month. I(We) understand and agree this
authorization is immediately cancelled for any electric account that
is disconnected, for any reason, and I(we) are responsible to pay any
balance due with a different form of payment.
I(We)
agree to pay all costs and fees that may be charged for any
transactions returned by THE FINANCIAL INSTITUTION for reasons
including, but not limited to, insufficient funds or account
closures. I(We) understand and agree that this authorization
can be cancelled by HOWELL-OREGON ELECTRIC COOP., INC. if, in the
opinion of HOWELL-OREGON ELECTRIC COOP., INC., it becomes necessary
for any reason to discontinue my(our) participation in this program.
I(We) understand and agree that if I(we) currently
read my(our) own meter to remit my(our) electric bill, I(We) am(are)
still responsible to report the current meter reading to
HOWELL-OREGON ELECTRIC COOP., INC. before the 10th of every month.
The debit amount will be calculated based on the submitted reading.
I(We) understand and agree that if HOWELL-OREGON ELECTRIC COOP., INC.
does not receive my(our) current meter readings by the 10th of the
month, my(our) account will not be automatically debited and I(we)
am(are) responsible to pay the amount due with a different form of
payment to ensure the continuation of my(our) electric service.
I(We) also understand and agree that this
authorization does not become effective until approved. I(We)
will receive notification from HOWELL-OREGON ELECTRIC COOP., INC.
when the approval process is complete.
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______________________________________
(Signature)
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_______________________________
(Date)
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After completing and signing this form, please return
this form and a voided check to the Cooperative office to begin the
approval process. If you have any questions on how to fill out
this form, please call the Cooperative office at 256-2131 or toll
free 1-888-HOE-POWER.
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