At Citizens Mutual Telephone Cooperative you can have your monthly bill automatically withdrawn from your account regardless of where you bank.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 on Card: ________________________________________________________

Address:_____________________________________________________________

Phone Number: ________________________________________________________

Credit Card Type: Master Card or Visa

Credit Card Number: ____________________________________________________

Expiration Date: ________________________________________________________

CVV2:________________________________________________________________
(Last 3 or 4 digit on back of card)

Signature: ________________________________Date: ______/_______/_______