AUTHORIZATION TO PAY
FIBER INTERNET BILL BY BANK DRAFT

Customer Name *

Customer Account # *

Customer Address *

City, State, Zip *

Customer Email Address *

Customer Telephone Number *

Date to be deducted from account: *

9th

20th

Bank Information

Bank Name *

Name on Bank Account *

Customers Bank Account Number *

Type of Account *

Checking

Savings

Bank Routing Number *

Account number
The second set of numbers following the character symbol immediately after your routing number is your account number. Sometimes the placement can be switched with the check number. To determine your account number, simply choose the longer number.

Routing number
The first set of numbers on the lower left corner of a check is the routing number. The routing numbers are 9-digit codes and the character symbol surrounding the numbers is not part of the routing number on a check.

check numbers

Agreement

Date *

Signature *

Please verify that you are human *

AUTHORIZATION TO PAYFIBER INTERNET BILL BY BANK DRAFT

Bank Information

AUTHORIZATION TO PAY
FIBER INTERNET BILL BY BANK DRAFT