Tuesday - May 13, 2008











P.O. Box 897 Mena, AR 71953 479-394-4140 or Toll Free 1-877-828-4074 or P.O. Box 121 Dierks, AR 71833 870-286-2012

AUTOMATIC BANK DRAFT

Spend more time doing the things
you want to do.

(information must appear as it does on your electric bill)

First Name
M. I.
Last Name

Home Phone

Business Phone

Address

Address

City

State
Zip Code

RMEC Account Numbers To Be Paid By Draft

Bank or Savings and Loan

City Bank Located

Name (as it appears on your bank account)

Checking or Savings Account Number
(all numbers at bottom of check from left to right)
sample: ( |:101020019|: 65050660" ' )

I authorize the Bank or Savings and Loan named above to pay my monthly Rich Mountain Electric Cooperative electric bill and to deduct each payment from my checking/savings account. This authority is to remain in effect until revoked by me in writing. I agree that each payment shall be the same as a check personally signed by me. I have the right to stop payment of a charge by timely notification to my Bank or Savings and Loan and Rich Mountain Electric reserves the right to terminate this draft service (or my participation therein).

E-mail address

Signature (type in your name as you would sign it)

Once your application is recieved, a Customer Service Representative will contact you for any additional information and confirm your request.

Note: You must mail voided check to:
1003 Mena Street
P.O. Box 897
Mena, Arkansas 71953

Thank you for allowing us to serve you.

Please e-mail Rich Mountain Electric if you have questions.

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