Headings ---------- Ellijay 06. Community Information is continued from previous page.
Page Text ---------- Save Time And Money With ETC's Automatic Draft No more checks to write or stamps to stick. You'll have more free time to do the things you enjoy and peace of mind knowing your phone bill is paid. This form can also be filled out online. How Will It Work? Your monthly billing statement will be mailed to you for review during your regular billing cycle. The amount due will be deducted from your account and applied to the bill on your regular billing date, as seen on your statement. For more information on your billing cycle or your billing date, please call our office at any of the main numbers listed below. What if there are charges on my bill I didn't make? Call us as soon as possible and we will investigate the charges for you. We can hold or adjust the Automatic Draft for the period or we can give you credit on your bill the following month. I don't bank locally, can I still use Automatic Draft? Yes, we can draft from ANY bank in the United States. How do I begin Automatic Draft? Fill out the information below. We will need your Routing Transit Number and your Account Number . You can find this information on your checks, or contact your bank and they will help you locate these numbers. Enclose a voided check from your checking account. Return this completed authorization form and the voided check to ETC Communications at the following address: P.O. Box O, Ellijay, GA 30540 I (we) authorize ETC and the financial institution below to begin electronic debit and/or credit entries to my (our) account listed below. CUSTOMER INFORMATION Name on Account:_____________________________________________________________________________________ Account #'s w/ETC: _______________________________________________________________________________ Daytime Number:______________________________________________________________________________________ Automatic Bank Draft Address:_____________________________________________________________________________________________ _____________________________________________________________________________________________________ BANK INFORMATION Name on Account: ____________________________________________________________________________________ Financial Institution: ___________________________________________________________________________________ Address of Financial Institution: __________________________________________________________________________ ______________________________________________________________________________________________________ Checking Account #: ___________________________________________________________________________________ Transit/Rtn #: _________________________________________________________________________________________ Terms of Agreement: I have an account(s) at the financial institution named and for debit entries, I have sufficient funds to pay such entries. Electronic debit or credit entries shall be initiated by ETC Communications to pay for monthly charges for the above listed accounts and the entries shall constitute my receipt for the transaction(s). No payment to ETC shall be deemed to have been made unless and until ETC receives actual credit. I also understand that if corrections of the entry are necessary it may involve an adjustment to my account. I understand my direct electronic payment of the bill amount will be debited on or after my cycle billing date. Signed __________________________ Date _______________________ 29
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