Ready Check authorization
To authorize your bank to pay your electric service bill from your checking account, please send a
VOIDED CHECK with this completed form to the Otter Tail Power Company at the address below.
Your Otter Tail Power Company account number: ___ ___ - ___ ___ ___ ___ ___ ___
Bank and bank account information
Name on bank account:
First name ___________________________________________________________ Middle initial ___________
Last name (or business name) ______________________________________________________________________
Name of your bank ______________________________________________________________________________
Address of your bank _____________________________________________________________________________
_______________________________________________________________________________________________
City _____________________________________________________ State ________ ZIP __________________
Checking account number _________________________________________________________________________
I
authorize my bank to draw against my bank account to pay my monthly electric service bills from
Otter Tail Power Company.
I
would like to make payments between the ______ and _____ days of each month. (Provide a 10-day
window.) Otter Tail Power Company will select a date that falls within 25 days of your billing date.
I also understand that I may cancel this arrangement at any time by giving notice in
writing to Otter Tail Power Company.
Signature
___________________________________________________________ Date ________________
(as shown on bank records)
Your email address _______________________________________________________________________________
Home phone ____________________________________ Daytime phone _______________________________
Attach a voided check blank and return to:
PO Box 2002
Fergus Falls, MN 56538 - 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~
Please enroll me in the Even Monthly Payment plan at the same time.
Send me information about Even Monthly Payment.
Enter 9-digit bank routing number Enter bank account number
