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Bankdraft Authorization Form Auto Bank-Draft FormMember Name(Required) First Last Member Account Number(s)(Required)Name Of Financial Institution(Required)Routing Number(Required)Bank Account Number(Required)Please enter a number greater than or equal to 0. Form does not retain 0s at the beginning of the number’s fields, if your account number or routing number starts with a 0, please let us know in the notes field. Verify Bank Account Number(Required)Please enter a number greater than or equal to 0.NotesVoided Check or Deposit SlipAccepted file types: jpg, png, pdf, jpeg, Max. file size: 512 MB. Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code (Required) Personal Business Account Type(Required) Checking Savings Name On Account(Required) First Last Email Phone(Required)Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Terms of Service(Required)I authorize Fannin Electric Cooperative, INC. to draft the amount due on my account each billing cycle from the bank account information entered on this form. This shall continue each billing cycle until I provide sufficient notice of cancellation. I agree to the terms of service.(Required)Signature(Required)CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
