AUTOMATIC BILL PAYMENT



AUTOMATIC BILL PAYMENT

CREDIT CARD

Automatic bill payment by recurring credit card is available to member-consumers of Midland Power Cooperative (residential customer classes only). It is an electronic funds transfer program that saves you the trouble of writing a check each month to pay your bill and instead offers you the convenience of having your bill automatically charged to your credit card (MasterCard or Visa) on a recurring monthly basis. Once you are signed up, you will receive your bill(s) marked “DO NOT PAY.” The amount of your bill(s) will be charged to your credit card on the 25th of each month. To sign up for Automatic Credit Card Payment :

- Complete the credit card information

- Print your name, address, telephone number, and sign the Authorization Form

- List all electric accounts you want to pay with recurring credit card

- Mail to: Midland Power Cooperative, 1005 E Lincolnway, Jefferson, IA 50129

MIDLAND POWER COOPERATIVE

AUTOMATIC BILL PAYMENT AUTHORIZATION –

RECURRING CREDIT CARD

I hereby authorize MIDLAND POWER COOPERATIVE (MIDLAND) to initiate monthly charges to my credit card listed below.

CREDIT CARD: ________MASTERCARD ________VISA

CARD NUMBER: _________________________________________________________

CARD EXPIRATION DATE: _________/________

Month Year

It is understood that this agreement may be terminated by me (either of us) at any time up to three business days before the 25th of the month by oral or written notice to MIDLAND. Any such notification to MIDLAND shall be effective only with respect to entries initiated after receipt of such notification.

_______________________________________________________ ________________________________________________________

Cardholder’s Name (Please Print) Address

_______________________________________________________ ________________________________________________________

Cardholder’s Signature City, State, Zip

________________________________________________________ ________________________________________________________

Date Telephone No.

IMPORTANT: Please list below all electric accounts you want paid monthly by CREDIT CARD with “Auto-Pay”

ACCOUNT NO: _______________________________________ ACCOUNT NO: ________________________________________

ACCOUNT NO: _______________________________________ ACCOUNT NO: ________________________________________

ACCOUNT NO. _______________________________________ ACCOUNT NO: ________________________________________

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