Yes, I want to participate in the Automatic Payment Plan.

I authorize Pierce Pepin Cooperative Services/SwiftCurrent Connect to instruct my financial institution to make payment to them from the account listed below on or about the due date indicated on my electric and/or internet/voice bill(s), or as soon thereafter as possible. I understand that I control my payments, and if I decide to discontinue this service at any time, I will notify Pierce Pepin Cooperative Services/SwiftCurrent Connect at least 15 days before the due date indicated on my bill(s) for the current month by phone, in writing, or by email. I also understand that Pierce Pepin Cooperative Services/SwiftCurrent Connect has the right to terminate my participation in the Automatic Payment Plan at any time and will notify me of such termination in writing or by email.

Member/Customer Information

Address
Apply Automatic Payment to These Accounts:

Electric Account(s):

Internet/Voice Account:

Financial Institution Information

Address
Type of Account:
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NOTE:  Allow up to 15 days from the date PPCS/SwiftCurrent Connect receives this form for automatic payment to be available. It is your responsibility to ensure that any amounts due, including past due amounts, during that 15-day period are paid.