Fill out this agreement
and attach a blank check marked "VOID", or a preprinted deposit ticket, from the
account of your choice. Return to Central Hudson with your next bill payment, or
mail directly to Cash
Processing, Central Hudson, 284 South Avenue, Poughkeepsie, NY 12601. Continue to pay your Central Hudson bill as you have in the past until you receive the first one that states: "This Amount Will Be Automatically
Deducted From Your Bank Account”.
PLEASE PRINT ALL INFORMATION CLEARLY
Your Central Hudson Account #_____________________________________________Date_____________________
Name on Account, above _______________________________________________________________________
Your Phone number ______________________________________________________
|
SELECT
PAYMENT DATE: Payment will be
deducted from your bank or credit union account (Circle One) 10
Days after billing date 15
Days after billing date On the Due
Date |
I (we) authorize Central Hudson Gas & Electric Corporation to deduct the amount due on my (our) gas and electric bill or water heater lease from the bank account indicated below, and also to make adjusting entries to the same account to correct any errors. I understand I must notify Central Hudson in writing to cancel this authorization.
Name of Financial Institution________________________________________________________________
Bank or Credit Union Account Number_________________________________________________________________
Name(s) on Account, above _______________________________________________________________________
Bank or Credit Union Routing Number _______________________________________________________________________
|
OPTIONAL GOOD NEIGHBOR FUND CONTRIBUTION To make a
donation to support the regions needy every time you pay your Central
Hudson Bill, fill out the amount ($1-$10) that you authorize to have
deducted from your bank or credit union account.
$_____.00 |
Authorized Signature(s)__________________________________________Date_______________
_____________________________________________________Date_______________
Attach a blank check marked "VOID", or a preprinted deposit slip, from the account specified, and return this application along with your next Central Hudson bill payment, or mail it directly to:
Cash Processing
Office
Central Hudson
284 South Avenue
Poughkeepsie, NY
12601