Bank Draft Authorization Form

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1 Lowercase letter
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Section I- Electric Account Information

Select One:

Establish New DraftCancel Existing DraftModify Existing Draft

PRECO Account Number

Phone Number

PRECO Account #

Phone Number

First Name on Electric Account

Last Name on Electric Account

Business Name on Account

Section II- Your Bank Account Information (establishing/modifying draft)

Type of Account (select one):

CheckingSavings

Name on Bank Account

First Name on Bank Account

Last Name on Bank Account

Financial Institution

ABA Routing Number

Bank Account Number

Check One

Authorize all active PRECO accountsAuthorize account listed above

Section III- Authorization

I authorize Peace River Electric Cooperative, Inc. (PRECO) to initiate debit entries from the financial institution listed above, in the amount of my monthly electric bill. I understand my account will be drafted on the due date indicated on each monthly statement.

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, an NSF fee will be assessed on my account. It is my duty to notify PRECO seven (7) days prior to a scheduled debit of any changes made to my designated account, including but not limited to closed status, bank ownership changes and account changes.

Authorized Signature

Date

Please attach a copy of voided check

Please continue to pay your electric bill until the

“Paid by automatic bank draft on <date>” appears on your bill stub.

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