PAYMENT BY BANK TRANSFER

AUTHORIZATION FORM

I, (We) hereby authorize Rural Electric Convenience Cooperative Co., hereinafter called RECC, to initiate debit entries to my (our) account at the financial institution named below for payment of my (our) electric bill, on a monthly basis. The debit will occur approximately two (2) days prior to the due date of the electric bill. This authority is to remain in full force and effect until RECC has received 20 days advance written notification from me (or either of us) of its termination.

NAME___________________________________________________________

RECC ACCOUNT NO.______________________________________________

FINANCIAL

INSTITUTION__________________________ BRANCH__________________

FINANCIAL

INSTITUTION ADDRESS____________________________________________

CITY_____________________________ STATE___________ ZIP___________

BANK

TRANSIT/ABA NO.___________________ ACCOUNT NO._________________

THIS IS A: (CIRCLE ONE):

DATE____________________ SIGNATURES___________________________

___________________________

The first month will satisfy pre-notification requirements; the second month will be the first actual transfer.

What Month Do You Want To Start?___________________________________

PRINT THIS FORM, FILL IT IN, AND RETURN TO: RECC, PO Box 19, Auburn, IL 62615

PLEASE ATTACH A BLANK VOIDED CHECK