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103 N Main, PO Box 20, Westby, WI 54667 vernoncom.coop (608) 634-3136 fax (608) 634-2000 Electronic Fund Transfer (EFT) Authorizaon Form Name(s) as shown on VC Co-op Account _____________________________________________________ VCC Billing Account Number ________________ Contact Number ________________________________ Billing Address __________________________________________________________________________ City, State, Zip __________________________________________________________________________ Financial Account Holder(s) (print) ___________________________________________________________ CHECK ONE Checking (Please aach a voided check) Name of Financial Instuon ___________________________________________________________ Account Number _____________________________________________________________________ Roung Number _____________________________________________________________________ Savings (Please aach a deposit slip) Name of Financial Instuon ___________________________________________________________ Account Number _____________________________________________________________________ Roung Number _____________________________________________________________________ Credit Card [Credit or Debit] Card Types Accepted Go to vernoncom.smarthub.coop to authorize a Credit or Debit Card. Card Holder Name CVV Card Number Expiraon Date By signing this agreement, I AUTHORIZE the Financial Instuon named above to pay my monthly Vernon Communicaons Co-op bill from the account listed above on the 10th of every month. (If the 10th falls on a weekend or holiday, payment will be taken out the following business day.) Vernon Communicaons Co-op has the right to cancel my use of the automac bill payment. If I wish to cancel future automac bill payments, I will nofy Vernon Communicaons Co-op three business days or more before the payment is scheduled to be made. Signature ______________________________________________ Date __________________________

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Page 1: Electronic Fund Transfer (EFT) Authorization Form · for Electronic Fund Transfer (EFT). Why Should I Choose EFT? Automatic withdrawal from your checking, savings or credit card,

103 N Main, PO Box 20, Westby, WI 54667 vernoncom.coop (608) 634-3136 fax (608) 634-2000

Electronic Fund Transfer (EFT) Authorization Form

Name(s) as shown on VC Co-op Account _____________________________________________________

VCC Billing Account Number ________________ Contact Number ________________________________

Billing Address __________________________________________________________________________

City, State, Zip __________________________________________________________________________

Financial Account Holder(s) (print) ___________________________________________________________

CHECK ONE

Checking (Please attach a voided check)

NameofFinancialInstitution ___________________________________________________________

Account Number _____________________________________________________________________

RoutingNumber _____________________________________________________________________

Savings (Please attach a deposit slip)

NameofFinancialInstitution ___________________________________________________________

Account Number _____________________________________________________________________

RoutingNumber _____________________________________________________________________

Credit Card [Credit or Debit] Card Types Accepted Go to vernoncom.smarthub.coop to authorize a Credit or Debit Card.

Card Holder Name CVV

CardNumber ExpirationDate

By signing this agreement, I AUTHORIZE the Financial Institution named above to pay my monthly Vernon Communications Co-op bill from the account listed above on the 10th of every month. (If the 10th falls on a weekend or holiday, payment will be taken out the following business day.) Vernon Communications Co-op has the right to cancel my use of the automatic bill payment. If I wish to cancel future automatic bill payments, I will notify Vernon Communications Co-op three business days or more before the payment is scheduled to be made.

Signature ______________________________________________ Date __________________________

Page 2: Electronic Fund Transfer (EFT) Authorization Form · for Electronic Fund Transfer (EFT). Why Should I Choose EFT? Automatic withdrawal from your checking, savings or credit card,

103 N Main, PO Box 20, Westby, WI 54667 vernoncom.coop (608) 634-3136 fax (608) 634-2000

Account Management Solutions

Bill Payment Options - Saves you time & moneySelect the AUTOMATIC payment method that’s right for you: Checking, Savings or Credit Card

vernoncom.smarthub.coop

Sign up and get a one time $5.00 credit for Electronic Fund Transfer (EFT). Why Should I Choose EFT? Automaticwithdrawalfromyourchecking,savingsorcreditcard,isthemostconvenientwaypossibletopayyouraccounteachmonth.Nomorecheckwritingortimedelaystogetyourbillpaidontime. Nomatterhowbusylifegets,thistakestheworryout.

Will I Get A Monthly Statement?WhetheryouchooseeBillorpaper,youwillcontinuetoreceiveamonthlystatement.Thisishowyouwill know how much to deduct from your account each month.

When Will My Account Be Debited? Your bill will be paid on the 10th of every month unless it falls on a weekend or holiday, then it will be deductedthefollowingbusinessday.DoINeedtoContactVernonCommunicationswithChangesor ExpirationDatestoMyCard?Pleasecontactuswheneverachangehasbeenmadetoyourcreditcard.

What is SmartHub?SmartHubprovidesconvenientaccesstoyourVernonCommunicationsCo-opaccountthroughpersonalcomputers,tablets,andmobiledevices,includingiPhones,iPadsandAndroidsmartphones.

A Worry Free Method for Bill PaymentElectronicpaymentsareautomaticallywithdrawnfromyourchecking,savingsorcreditcardaccounteach month.• Yourbillisalwayspaidontime• Your check will not get lost or stolen• Noworriesofidentitytheft• You can view your account wherever you are.

Safe & SecureSmartHubprovidesasafeandsecureenvironmentforbillpaymentsandtransactionsbetweenVernonCommunicationsCo-opandyourfinancialinstitution.


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