EZ-Bill for Automatic Savings (Secure Form)

EZ-Bill combines paperless billing and automatic bank draft to save money, time, energy and keep our environment healthy for future generations. By signing up for EZ-Bill you are also agreeing to receive future bill notifications online (no more paper bills) and your payment will be automatically drafted each month from your checking account.
Member Information
First Name:*
Last Name:*
E-mail Address:*
Blue Ridge Account Number:*
Billing Address:*
State:* Zip:*
County where service is located:*
Home Phone: *
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Cell Phone:
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Bank Information
Set up your bill to be drafted from your checking or savings account when your bill is due.

Bank Name:
Bank Routing Number:*
Bank Account Number:*
Acct. Type:*
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.