REVOCATION OF AUTOMATIC BILL PAYMENT PLAN

Effective this date

I hereby revoke my automatic payment plan on my electric service account(s) at Fayette Electric Cooperative, Inc.

I understand that my

checking/savings account

credit card

will no longer be charged on the 10th of the month for the amount of my electric service account(s).

Cardholder’s Signature

Cardholder’s Name

Daytime Phone Number

Member’s Name

Member’s FEC Account Number(s) - List All

Home Phone Number

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