Payment Methods – checke one



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| 605-692-6325 PO Box 588 – Brookings, SD 57006-0588 605-692-6211 |

When you sign up for Automatic Payment

Bill(s) are produced as-usual. They can be mailed to you at the end of each month, or you can elect to be notified via e-mail when your bill is available online.

1. If you choose the bankdraft payment option, your bill will have

“Bank Deduct – Do Not Pay” or “Auto Pay” printed on it.

2. Your bankdraft payment will be processed on the 10th, or the next working day, of each month.

3. The bankdraft payment option that you select will continue until you notify our office.

4. If a payment request submitted to your bank is returned unpaid, we will contact you by notice.

Please complete the form below to sign up.

Contact us at 605-697-8468 with questions.

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BANKDRAFT AUTOMATIC PAYMENT AUTHORIZATION

|Service(s) to be paid – CHECK ONE OR BOTH |

|{attach sheet for additional Swiftel or utility account numbers} |

| |

|______ Utility Acct No. ____________________________ |

| |

|______ Swiftel Acct No. ____________________________ |

NAME on billing account ______________________________________

Service Address __________________________________________

Mailing Address __________________________________________

| |

|Type of Acct ____ checking{attach voided check or check image} |

|____ savings |

| |

|BANK INFORMATION--- |

| |

|Acct Number _______________________________ |

|Name __________________________________ |

| |

|Address __________________________________ |

| |

|__________________________________ |

| |

|Phone No. _________________________ |

| |

I authorize Brookings Municipal Utilities/Swiftel Communications to process a monthly

payment in the method indicated above for the listed utility/telephone account(s).

Signed _________________________________________ Date _________________

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