EZ Pay Form - Jackson REMC

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REMC Account Number(s)

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PLEASE SUBMIT VOIDED CHECK — Jackson County REMC, Attn: Billing Department, PO Box K, Brownstown, IN 47220-0311

Routing Number

I authorize Jackson County REMC to draw monthly drafts on my bank account, shown above, for the payment of my monthly electric bill. I understand that I can discontinue my participation in the E-Z Pay Plan by notifying Jackson County REMC, and my bank may also terminate this agreement within 10 days of written notice. I understand that Jackson County REMC reserves the right to limit participation in the E-Z Pay plan to customers whose accounts are in good standing.

Please start withdrawing on ____________________ 17th, ____________ .

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E-Z Pay Plan Authorization Form