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AUTHORIZATION AGREEMENT FOR CREDIT CARD PAYMENTS
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I authorize Western Iowa Power Cooperative, hereinafter called COMPANY, to use the credit card name and number listed below for payment of my monthly electric bills:
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| Please circle Credit Card: |
VISA |
MASTERCARD |
DISCOVER |
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| 16 Digit Account #___________________________________ Expiration Date________________ |
| This authorization will remain in effect until COMPANY has received written notification from me of its termination or the date of the card has expired at which time COMPANY will notify me that a new agreement needs to be signed. |
| Signature_______________________ Date_________________________ |
| Name__________________________ |
| Address________________________ |
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| REC Acct # to Credit__________________ |