Change Credit Card Info
Credit Card Authorization (Visa, Discover, or MasterCard)
Name of Cardholder: Bluebonnet Account Number:
Credit Card Number: Expiration Date:
Member Mailing Address:
I (we) have hereby given authority to Bluebonnet Electric Cooperative, Inc., hereafter called the Cooperative, to
initiate charges to my (our) Visa, Discover, or MasterCard credit card account each month for the monthly bills on
my (our) electric account.
Signature of Cardholder and Date Signed: Daytime Phone Number:
I (we) understand that if my (our) account being charged for my (our) electric bill is insufficient to pay my (our)
bill I (we) will remain liable and responsible to timely pay my (our) bill including any late fees that may apply.
I (we) further understand that I (we) may revoke this authorization to debit my (our) account for my (our) electric
bill. If I (we) revoke this authorization, I (we) understand that I (we) must give written notice of such
revocation to the COOPERATIVE. This authority is to remain in full force and effect until the COOPERATIVE
has received written notification from me (or either of us) of its termination in such time and in such manner as to
afford Bluebonnet a reasonable opportunity to act on it.
You will still receive a monthly bill showing the amount automatically charged to your credit card.
Please return the completed form with your original signature to the address shown below or to one of our
Member Service Centers.
Bluebonnet Electric Cooperative
P.O. Box 729
Bastrop, Texas 78602