Coast EPA
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Payment Options

Authorization Agreement for Automatic Payments

Note: Please complete and return this authorization form along with a VOIDED check on the account that you would like drawn on monthly.

IMPORTANT INFORMATION
Thank you for choosing the easy and safe way to pay your monthly electric bill, automatic bank draft. Each month prior to your bank account being drafted, you will receive your electric bill statement that will detail your usage and amount billed. It's that simple!



Name (as Shown on bill):
 Electronic Service Account No. (found on bill):
Phone Number:
 Email Address:
Name as Shown on Bank Records:
 Name of Bank Branch:


Bank's Address:

Street
Bank's Address:

City
State
Zip Code
Checking Account No.:
Bank Transit No.:


    Please review your information, then print and return the form. Address information can be located here
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