Automatic Payment Authorization

Although not required, we do offer convenient AutoPay options for our customers. You can choose between an automatic ACH draft from your checking or savings account, or automatic payments from your credit or debit card.

ACH DEBIT occurs on or near the 5th of every month.

I hereby authorize Corn Belt Telephone to initiate debit entries to my account indicated below, as well as authorize the Financial Institution named below, to debit the same account for services billed by Corn Belt Telephone.

Name on Corn Belt Account*

Full Name

Name on Bank Account if Different

Type of Account*

CheckingSavings

Institution Name*

Routing Number*

Account Number*

This authority is to remain in full force and effect until Corn Belt Telephone Co. has received written notification from me of its termination, in such time and manner as to afford Corn Belt Telephone and the named Financial Institution a reasonable opportunity to act on it.

Please attach a voided check

Signature*

Today's Date*

Please verify that you are human*