AMICALOLA EMC

FAX NO. (706) 253-5251

Credit card debit is now available through Amicalola Electric Membership Corporation. Anyone who is a member may have the convenience of paying his or her electric bill each month by credit card. All you have to do is complete the form below and return it with your next bill payment. All future bills will be debited until you request to be removed from the automatic service. Your bill will be mailed to you each month as before to give you information concerning your kilowatt-hour usage, as well as the bill amount.   However, it is your responsibility to inform us in writing of changes or updates to your card, including new expiration dates and new CVV2 Codes.

By having your account debited, you will eliminate; 1) problems with mail delivery; 2) forgetting to pay your electric bill; 3) the bother of writing a check; 4) the chore of mailing your payment; and 5) the saving on postage. Best of all - YOU NEVER PAY A LATE CHARGE.

If you have any questions, please contact the Amicalola EMC office in Jasper: (706) 253-5200.

I HEREBY AUTHORIZE AUTOMATIC DEBIT FROM CREDIT CARD EACH MONTH

Name:_________________________________________________________________

Amicalola EMC Account #:_________________________________________________

Phone #:_______________________________________________________________

Name on Credit Card:______________________________________________________

Credit Card Account #:_____________________________________________________

CVV2 Code: (can be found on the back of card on the signature line, last 3 digits:__________

Expiration Date:________________________________

Signature:______________________________________________ Date: ______________

(We MUST have your signature for processing)