Autopay Agreement

The Smart Hassle-Free Way To Pay Your Bill.

AUTHORIZATION AGREEMENT FOR AUTOMATIC BILL PAYMENT

- Customer Name(s)*
- Phone*
- Name of Utility: Independence Light & Power, Telecommunications
  Utility ID: 42-0862266
- I (we) hereby authorize to pay Independence Light & Power, Telecommunications, hereinafter called UTLIITY, the total due each month, as shown on the monthly billing, by deducting the amount from my (our) Checking (includes NOW or share draft) or, Savings account indicated below and the BANK named below. All transactions are debited on your due date each month. This will commence with your next billing.
- Account Type*
  - Checking
  - Savings
- Bank Name*
- Branch*
- Bank Location*
  City State / Province / Region ZIP / Postal Code
- Routing Number*
- Account Number*
- PLEASE INCLUDE A VOIDED CHECK*
  Upload picture via phone or scanned image. (acceptable formats: jpg, jpeg, gif, png, pdf)
- Consent*
  Agree
  This written authority is to remain in full force and effect until UTILITY and BANK have received written notification from me (or either of us) of its termination in such time as to follow UTILITY and BANK a reasonable opportunity to act on my request
- Date*
  Date Format: MM slash DD slash YYYY