Nodak AutoPay

Nodak Electric Cooperative, Inc.
Date
Date Format: MM slash DD slash YYYY
Time

: HH

MM
Sign-Up and Authorization for Automatic Payment Plan
Please fill in all fields
Nodak Account Number*
Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Banking Information
Financial Institution*
Routing #*
Account #*
Account #*
Account Type*
*
By clicking the submit button below, I authorize Nodak Electric Cooperative, Inc. (Nodak) and my financial institution to initiate entries to debit my account described below. I understand that this authority is to remain in effect until Nodak has received notification of its termination and shall be received in such time as to afford Nodak a reasonable opportunity to act on it.
I agree
Signature*
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Nodak Electric Cooperative, Inc.