Electronic Direct Payment Authorization Agreement

Pioneer is making it easier to pay your monthly electric bill. You may make your payment automatically by signing up for Direct Payment. Each month you will receive a statement from Pioneer letting you know the amount due. On the due date of each month, the net bill amount will be deducted from your account. To start Direct Payment please complete the authorization form below and return it to our office. Along with the completed form you must send a VOIDED CHECK or deposit stub from your desired account.

Date:

Member Name: Pioneer Account Number:

Service Address: City: State:

I wish to initiate automatic utility payments to Pioneer Rural Electric Cooperative, Inc. Therefore, I hereby authorize Fifth Third Bank to initiate debit entries and, if necessary, credit entry adjustment(s) for any debit entry in error to my checking account indicated below:

Bank Name: Routing Number
 
Bank Address Bank Account Number

This authority is to remain in full force and effect until Pioneer Rural Electric Cooperative, Inc., has received written notification from me of its termination.

Signature: _____________________________________   Social Security Number
         
Signature _____________________________________   Social Security Number

**PLEASE NOTE You must include both signatures and social security numbers if you have a joint checking or savings account.

Complete form, print and return to:
Pioneer Electric Cooperative
344 West U.S. Route 36
Piqua, OH 45356