Stop Automatic Payment

STOP AUTOMATIC PAYMENT

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Customer ID*
Last 4 Digits on Social Security # on Account:*
Effective Date*
MM slash DD slash YYYY

Must be 7 days prior to due date
Authorization*
I agree to the Stop Automatic Payment policy.
I (we) hereby authorize to stop automatic payment of my (our) natural gas bill associated with the Customer ID and effective date listed above. ( Effective date must be 7 days prior to due date or account may be drafted for that billing cycle. )
Depository Information
Depository Name*
Branch*
City*
State*
Checking/Savings Routing Number*
Checking/Savings Account Number*
Customer Agreement
Agreed Upon by:*
Date*
MM slash DD slash YYYY
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