Bank Draft(Secure Form)

Member Information

First Name:*
Last Name:*
E-mail Address:*
Blue Ridge Account Number:*
Billing Address:*
State:* Zip:*
County where service is located:*
Home Phone: *
- -
Cell Phone:
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Bank Or Credit Card Information
Set up your bill to be drafted from your checking or savings account when your bill is due, or provide your credit card information and your card will be charged monthly.

Select payment method:*
Bank Draft Credit Card
Bank Name:
Bank Routing Number:*
Bank Account Number:*
Acct. Type:*
Name on Credit Card:*
Credit Card Number:*
Card Type:*
Exp. Date:*
As a member of Blue Ridge Electric Membership Corporation, PO Box 112, Lenoir, NC 28645, I do hereby authorize said cooperative to draw monthly drafts on my account in your bank for current electric service and/or goods or services furnished to me by the said Cooperative, and I do hereby authorize you to honor such drafts until such time as I may revoke this order.