At Citizens Mutual Telephone Cooperative you can have your monthly bill automatically withdrawn from your account regardless of where you bank. A copy of your bill will be sent to you at the first of each month. The deduction is not taken from your account until the 20th of the month.

Simply fill out the form below, attach a voided check, and return both to our office. Your monthly telephone bill will be paid without any hassles or worry! For more information call our business office at 664-2074.

Name: ________________________________________ Phone: __________________

Address:_______________________________________________________________

City: ___________________________________ State: _____________Zip: _________

Bank:___________________________ Your Account #: _________________________
I hereby authorize you to receive payment directly from my bank for my monthly telephone bill on the 20th of the month effective immediately and continuing thereafter until this authorization is revoked by me in writing.

Signature: _________________________________________Date:_____ /_____/_______