I hereby authorize, Richmond Power & Light, to initiate debit entries from my account indicated below for recurring electric bills. I understand that if corrections in the debit amounts are necessary, it may involve an adjustment (credit or debit) to my account. This authority is to remain in full force and effect until written notification from me of its termination in such time and in such manner as to allow Richmond Power & Light reasonable time to act on it. I also agree to provide Richmond Power & Light at least 30 days notice before closing the active bank account being used for debit entries. If my account has insufficient funds and my bill is returned to Richmond Power & Light, I agree to also pay the $20.00 service charge added to my electric bill.

Please print:

Name: ______________________________ Home Phone:______________

Customer Number:_____________________ Work Phone:______________

Service Address: _______________________________________________

Mailing Address (if different): _____________________________________

Social Security Number: _________________________________________

Bank Name: __________________________________________________

Checking Account Number: ______________________________________

Routing Transit Number: ________________________________________

Signature: ______________________________ Date: _________________

Please complete an authorization for each contract that you wish to be handled by direct debits. PLEASE REMEMBER TO ATTACH A VOIDED CHECK!

Mail to:       Direct Payment, Richmond Power & Light, P.O. Box 908, Richmond, IN 47375-0908