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Great Plains Communications Automatic Bill Pay
It’s just too easy!
Customer Name (Please Print):
Customer Account Number:
Customer Telephone Number:
With your approval, your financial institution or the credit card of your choice (MasterCard, Visa or Discover) can
automatically pay your monthly Great Plains Communications’ bill. (An itemized bill will be sent monthly. Your
statement will verify the bill has been paid.)
• Please choose ONE Auto Pay option.
• Return this completed authorization to Great Plains Communications. We will do the rest!
Checking/Savings Account Credit Card
(Please use blue or black ink) (Please use blue or black ink)
Please Circle One:
Financial Institution Name
:987654321: 0123456789 12345
ROuTING NuMBER ACCOuNT NuMBER CHECK NuMBER
Credit Card Number
Routing Number (should be 9 digits, see example above)
Bank Account Number
You are hereby authorized to charge my credit card to
Checking Savings pay my monthly statement.
You are hereby authorized to charge my bank account
to pay my monthly statement.
TO CANCEL THIS AuTHORIzATION, YOu MuST NOTIFY GREAT PLAINS COMMuNICATIONS iN
writiNg FIVE (5) BuSINESS DAYS PRIOR TO THE NEXT DuE DATE.
PLEASE MAIL TO GREAT PLAINS COMMuNICATIONS, PO BOX 500, BLAIR, NE 68008. REMEMBER
TO MAKE A COPY FOR YOuR RECORDS. APF0806