Bank Draft Authorization Form

  • Customer Information

  • (as shown on Electric Bill)
  • Bank Information

  • Important Note & Signature

  • It will not be necessary for North East Mississippi Electric Power Association or anyone employed by it to sign such drafts or checks, and I agree that your rights in respect to each such draft or check shall be the same as if issued and signed personally by me. I further agree that you shall be under no obligation to furnish me with any special advice or notice in writing or otherwise of the presentment or payment of any such draft or check or the charging of the same to my account. This authorization is to remain in effect until revoked by me in writing, and until you actually receive such notice I agree that you shall be fully protected in honoring any such draft or check.

    I hereby authorize my electric bills to be paid by my bank.

  • Please attach a copy of a Voided Check for account verification.