Automatic Draft Form
To be enrolled in the automatic draft or reoccurring credit card plan, please complete the fields below.
Billing Address
Please select how you would like to be enrolled in automatic payments:
Account Information
Credit Card Information
Please select which card you want to enroll in automatic payment:
By checking this box, I authorize Parke County REMC and the financial institution named below to initiate entries to my checking, savings, or credit card account. This authority will remain in effect until I notify the REMC in writing to cancel it in such time as to afford the financial institution a reasonable opportunity to act on it. If the entry is returned to REMC by the financial institution for any reason including but not limited to non-sufficient funds, cancellation of account, information provided below being incorrect, or changes to information provided below, REMC will reverse the payment. I will be responsible for making the payment plus a $30.00 denial fee.
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