SAV-A-CHECK AUTOMATIC BILL PAYMENT

Save Time... Save Money...

Sign up for Auto Bill Bay

Did you know that we offer an Automatic Bill Payment option? It is very easy to set up! All we need from you is a voided check or a deposit ticket and your signature on the form below. You will still get your bill every month, the only difference is that you don’t have to write out a check, find a stamp and get it in the mail. If you go on vacation you don’t have to worry about getting it paid on time. Your payment will be automatically deducted from your checking/savings account on the 18th of every month.

If you have any questions about Auto Bill Pay please call or stop into the office. A copy of the Authorization form has been printed below for your convenience. You can just fill it out, attached a voided check and send it in with your payment. We’ll take care of the rest!

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Authorization for Save-A-Check Automatic Bill Payments
to sign up for Save-A-Check, simply complete and sign the following authorization form.

I (we) authorize Cochrane Cooperative Telephone Co. to initiate entries to debit my (our) account described below:

Checking Account No. ______________________________________________________

or Savings Account No. _____________________________________________________

Financial Institutions’s Name: ________________________________________________

Financial Institution’s Address: _______________________________________________

***Attach a voided check or savings slip, or provide the Financial Institution’s Routing Number.

(the routing number can be found on the bottom left of your check or savings deposit slip.)

This authority is to remain in full force and effect until Cochrane Cooperative Telephone Co. has received written notification from me (or either one of us ) of its termination in such time and manner as to afford Cochrane Cooperative Telephone Co. a reasonable opportunity to act on it.

Signature: ________________________________________________________________

Full Name (printed): _______________________________________________________

Date: _____________________________
Telephone number: ______________________

(Optional for joint account)

Signature: ________________________________________________________________

Full Name (printed): _______________________________________________________

Date: ____________________________
Telephone number: ______________________