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

Authorization for Enrollment in Automatic Bill-Paying - Credit Card

Name ______________________________________________________________
Address ____________________________________________________________
City _________________________ State ___________ Zip ___________________
Phone __________________ Co-op Account Number ________________________
Credit Card    ___Mastercard  ___Visa  ___American Express  ___Discover
Credit Card Number ___________________________ 3-Digit Security Code* _____
Name on Credit Card __________________________________________________
Credit Card Expiration Date _____________________________________________

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.  All credit card drafts will be made on the 5th of the each month.

Signature _______________________________ Date _______________________

*The 3 digit security code is located on the back of your credit card and must be included or we can

 not enroll you into automatic bill-pay.