Authorization for Automated Bill Payment



    Check one:



    Important: Please attach a voided check with this form to ensure accurate processing.



    I authorize you to charge my checking/savings account monthly in the amount of my monthly bill to make that deduction payable to Arkansas Telephone Company. In making this authorization, I agree to all Terms & Conditions of Authorization. This Authorization is to remain in full force and effect until Arkansas Telephone Company has received written notification from me of its termination in such time and in such manner as to afford Arkansas Telephone Company and the above named Financial Institution a reasonable opportunity to act on it.