Bank Draft Instructions Please complete this form and submit it by clicking the Submit button at the bottom of the page. Please provide a voided check or a scanned copy of a check. Instructions for providing a check or a copy of a check are included at the bottom of this form. All draft authorizations are processed immediately after they are received. Upon receipt of your next bill, you will see in the message box the draft status of your account. If you have any questions, please contact our office Monday through Friday, 7:00 AM until 5:00 PM. *Coastal Electric Account Number:*Member Name: Bank Account Information NOTICE: Some banks put the Check Number between the Routing Number and the Account Number. Please LOOK CAREFULLY AT YOUR CHECK. *Bank Name: *Type of Account: Checking Savings Provide the last 4 digits of your bank account number: *Account Number (last 4 digits): Name and Address of Bank Account Holder *Name(s) on Account: *Mailing Address: *City: *State: *Zip: *Daytime Phone Number: *EMail Address: Comments: I hereby authorize Coastal Electric Cooperative to initiate entries to my checking account at the financial institution listed above and, if necessary, to initiate adjustments for any transactions credited in error. This authority will remain in effect until Coastal Electric Cooperative is notified by me in writing to cancel it in such time as to afford Coastal Electric Cooperative and my financial institution a reasonable opportunity to act upon it. Please note your next electric bill, immediately after this authorization WILL NOT DRAFT due to a bank required pre-note process to verify your bank information is correct. Once this automatic step is complete your bill will be paid by draft without further action. Watch the message box on your bill. Once the pre-note authorization is complete the date of the next scheduled draft will be shown. Click here to draw your signature. Signature With your mouse, draw your signature. Then click Finish. (MM/DD/YYYY) There are five methods available for submitting additional documentation. Method 1: Electronic File Upload You can submit electronic copies of images or PDF documents with the file attachment tool below. If you are using a smartphone or a tablet with a camera then you can take a picture of the document from here. If you have multiple files, you can combine your electronic documents into one zip file (using your zip software) and attach the zip file to this application. The files will be automatically extracted after the form is submitted. Attach Document: Method 2: Document Upload Tool After you submit the online application, you can provide additional materials by using our online document upload tool. You will receive more information about the upload tool in the confirmation email sent to you after the application is submitted. Method 3: Electronic Mail After submitting this online application, you will receive a confirmation email. By replying to this email you can submit electronic copies of scanned images and PDFs by attaching them. Use the personalized subject provided to ensure your documents get delivered to the right place. Note: Email is not encrypted and is not as secure as the other methods. Method 4: Fax Fax copies of pictures and paper documents to the fax number below. Method 5: Postal Mail Mail copies of pictures and paper documents to the address below. NOTE: If you send additional information by mail, do not bind, use staples, or put your documents in a portfolio. Use only paper clips to hold information together. Coastal Electric Employee Employee Title Coastal Electric Cooperative 1265 S Coastal Highway Midway, GA 31320 employee@coastalemc.com Phone: 912-884-3311 Fax: 912-884-2362
