Bank Draft Change Form

Make Changes to your Automatic Bank Draft

This form is only for changes when Auto Bank Draft is set up using a bank account.

Print this form.

Name
(as it appears on your electric bill)*

Name
(as it appears on your electric bill)

C&L Account Number(s) to draft*

C&L Account Number(s) to draft

Current Billing Address*

Street Address

City

State

Zip Code

Day of month to draft*

Please Specify

Account Type*

Checking

Savings

Please Specify

Bank Account Number
(Maximum of 15 numbers - Do not include check number)*

Bank Account Number
(Maximum of 15 numbers - Do not include check number)

Bank Routing Number*

Bank Routing Number

Name on the Bank Account *

Name on the Bank Account

Name of Bank*

Name of Bank

City/State of Bank*

City/State of Bank

I authorize the bank or financial institution named above to pay my monthly C&L Electric Cooperative electric bill and to deduct each payment from my checking/savings account. I have the right to stop payment of charge entries by notifying the Bank prior to the time the account has been charged. This authority is to remain in effect until the Cooperative and bank have received notification from me of its termination in sufficient time to act on it.*

I agree

Please Specify

Type your name as you would sign it*

Type your name as you would sign it

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Main Phone: (870) 628-4221

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