MES Bank Draft Program
MCMINNVILLE ELECTRIC SYSTEM
DEBIT AUTHORIZATION FORM
| (we) hereby authorize McMinnville Electric System, hereinafter called MES, to initiate debit entries to my (our) account indicated below and the financial institution named below, hereinafter called Financial Institution, to debit the same to such account for the electric bill I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U S law
Customer Number
Email
Customer Name
Customer Address
Customer Phone
Financial Institution
Financial Institution Address
City, State, Zip
Routing Number
Account Number
Type of Account (checking / savings)
Amount: The utility bill is mailed monthly to customer fifteen (15) days before the due date each month The net amount of your utility bill will be deducted on the due date or the following weekday if it falls on a weekend or holiday
Frequency:
Start Date (if recurring):
Date of debit (s):
If the debit is recurring and the date of the debit falls on a non - banking day, the debit will be processed on the next banking day and will not be processed prior to the authorized date
(Note: For varying amounts the company must send, based on NACHA Operating Rules, written notification of the amount and the date on or after which the transfer will be debited at least ten (10) calendar days in advance of the debit If the date varies, the Rules state that the Originator must send the Receiver notification of new date at least seven (7) calendar days in advance of the debit)
This authority is to remain in full force and effect until revoked by either party upon written request in such time and manner as to afford MES and Financial Institution a reasonable opportunity to act upon it
Date
Select Today's Date
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DD
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YYYY
Name
By typing your name here, you hereby authorize MES to enroll you in the Bank Draft Program.
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