Wood County Electric Cooperative
501 S. Main
P.O. Box 1827
Quitman, TX  75783

Authorization for Enrollment in Automatic Bill-Paying – Bank Draft

Name ______________________________________________________________
Address ____________________________________________________________
City _________________________ State ___________ Zip ___________________
Phone __________________ Co-op Account Number _______________________
Name of Financial Institution ____________________________________________
Financial Institution Routing Number ______________________________________
Checking Account Number _____________________________________________
Name on Account _____________________________________________________  
Day of month to draft your account ___ 5th ___12th ___19th ___26th (Please select

first and second choice).

Levelized Billing     Yes______  No______ (requires 1 year membership & "0" balance)

I hereby authorize Wood County Electric Cooperative and the financial institution named above
to draw monthly drafts on the account indicated above for the payment of my monthly electric bill.
I understand that I can discontinue my participation in automatic bill-paying by notifying Wood
County Electric Cooperative in writing.

Signature _______________________________ Date _______________________