Get Automatic Payment Plan Authorization Form - Bloomer

The Automatic Payment Plan Authorization Form is designed to facilitate a seamless billing process for users of Bloomer Telephone Co. This guide provides step-by-step instructions to help users fill out the form accurately online.

Follow the steps to complete your Automatic Payment Plan Authorization Form.

1. Press the ‘Get Form’ button to acquire the Automatic Payment Plan Authorization Form and access it for editing.
2. Begin by entering the name(s) appearing on your Bloomer Telephone Co. bill in the designated field.
3. Next, provide the phone number listed on your bill to ensure the company can contact you regarding your account.
4. Fill in your complete billing address, including street address, city, state, and zip code.
5. Add your home phone number and, if applicable, your work phone number in the specified spaces.
6. Indicate the name of your financial institution where your payments will be withdrawn.
7. Next, provide the address of your financial institution, including city, state, and zip code.
8. Select whether your payments will come from a checking or savings account by marking the appropriate box.
9. Enter the phone number associated with your financial institution in the relevant field.
10. Input your account number to facilitate the automatic payment setup.
11. If the payments will be deducted from a checking account, make sure to attach a voided check. If using a savings account, attach a deposit slip that shows your account number.
12. Understand that Bloomer Telephone Co. retains the right to cancel your automatic payment plan. You must provide a written notice 30 days prior to any cancellation request.
13. Provide your signature, and if applicable, the signature of the second account holder. Remember that both signatures are necessary if the account is under two names.
14. Finally, write the date of signing and ensure all necessary attachments (voided check or deposit slip) are included before mailing the form to Bloomer Telephone Co. at the specified address.
15. You may also choose to save your changes, download, print, or share the form as needed.

Complete your Automatic Payment Plan Authorization Form online today to enjoy a hassle-free billing experience.