UCEMC - Bank Draft Payment Form

UPPER CUMBERLAND ELECTRIC MEMBERSHIP CORPORATION - Bank Draft Payment Form

The cooperative offers it members the opportunity to pay their electric bills by subscribing to the Bank Draft Payment Plan. Any member who can pay bills by check may participate in the plan. This process is accomplished by electronic bank debit each month on or near the due date of your bill. You may join the plan by signing an authorization statement, which will be forwarded to your bank. The service is free and helps insure against late payment charges from forgetting to pay your bill on time. It can also be a time and money saver over writing and mailing checks or driving to your nearest office to pay in person.

Subscribers receive their bills each month as usual. After their first payment by draft, the next bill will indicate "PD BY DRAFT". Members may withdraw from the Bank Draft Payment Plan at any time. The cooperative reserves the right to terminate any member’s participation if the member’s bank fails to honor the authorized drafts.

If you are interested in subscribing, please complete the form below and return to the Cooperative. Please mail to:

UCEMC, PO BOX 159, CARTHAGE, TN 37030-0159

Please attach a Voided Check

Upper Cumberland Electric Membership Corporation - Authorization for Bank Draft

I hereby authorize UCEMC to draft my checking or savings account indicated below for payment of my electric bill.

BANK NAME & ADDRESS________________________________________________

BANK TRANSIT NO.________________BANK ACCOUNT NO_________________

NAME____________________________ UCEMC#_______________CYCLE_______

This authorization is to remain in effect until UCEMC has received written notification from cooperative member and UCEMC has had a reasonable amount of time to act upon it. If any of the above bank data is not correct, the bank is requested to provide UCEMC with correct information.

Applicant signature_____________________________________________________________

Employee Signature______________________________Date___________________________