Muscle Shoals Electric Board, AL - START Bank Draft Authorization

Name on utility bill account: Name on utility bill account: First Last
Phone: Phone: - ### - ### ####
Email:
Address: Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
MSEB account number(s):
Bank Name:
Bank account number:
Attach a copy of a voided check:

Attach Files
Agreement:

Agreement: I hereby authorize MUSCLE SHOALS ELECTRIC BOARD, herinafter called MSEB to initiate debit entries to my checking account indicated and the depository (Bank or Credit Union), to debit the same to such account. The authority is to remain in full force and effect until MUSCLE SHOALS ELECTRIC BOARD receives written notification from me of its termination FIFTEEN (15) days prior to the effective date of termination. I understand that the debit to my checking account will occur on the due date of my utility bill and that I will receive my utility bill at the regular time noting that it will be paid from my bank account. I further understand that should a debit to my checking account be rejected because of insufficient funds TWO (2) times, I will no longer be eligible to participate in the preauthorized payment program.
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