AUTOMATIC CREDIT CARD PAYMENT AUTHORIZATION CREDIT CARD AUTHORIZATION Automatic Credit Card credit card credit card billing credit card information Credit Card Payment authorization form credit card s

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AUTOMATIC CREDIT CARD PAYMENT AUTHORIZATION CREDIT CARD AUTHORIZATION Automatic Credit Card credit card credit card billing credit card information Credit Card Payment authorization form credit card s Powered By Docstoc
					        AUTOMATIC CREDIT CARD PAYMENT AUTHORIZATION
The Automatic Credit Card Payment Program is designed to automatically pay your power bill
each month using your credit card. No more writing checks, no more worrying about whether
or not you remembered to pay your bill. Your credit card is charged on the 21st of each month
(or the next business day if the 21st is not a normal business day). You will still receive a copy
of your bill for your records. You have the choice of using VISA, MasterCard, or Discover cards
for this program. If you would like to enroll in this program, please complete the information
requested below and mail this completed form to San Miguel Power Assn., PO Box 817, Nucla,
CO 81424, or fax the form to 970-864-7257. Receipt of a completed form authorizes San
Miguel Power Assn. to charge the amount of your power bill each month to your credit card.
This agreement can be terminated at any time by either party by written notice. In the event
that the charges are denied by your credit card company, you will be notified and requested to
pay by other means. If the charges are denied, late fees and/or penalty fees may be assessed.

                          CREDIT CARD AUTHORIZATION
              Type of card:   _____ VISA       _____ MasterCard       _____ Discover

Credit Card No:                                               Expiration Date:

Name (as it appears on the card):

Signature of authorized individual:

Today’s date:                                   3-digit security code on back of card:

SMPA account number(s) you would like to pay using this card:



                                      FOR OFFICE USE ONLY

Start date:                            Name on the account:

Comments:


Note: If you have any questions regarding this form or the program, please call the billing
department at 970-864-8133.