Cascade Communications Company 106 Taylor Street SE, PO Box 250 Cascade, IA 52033-0250

Automatic Payment Plan
Authorization Agreement For Pre-Authorized Payments

With the Automatic Payment Plan, your bank or financial institution makes your payments directly to Cascade Communications Company on a monthly basis. All you need to do is to provide some information and we will do the rest. You will continue to receive a monthly bill, but we will automatically handle your payment through your financial institution.
To sign up for this free service, please fill out the form and send it with your personal voided check or copy of a voided check. The account must be current. If it is a joint account, both signatures are required on this application.


I (we) hereby authorize Cascade Communications Company to initiate debit entries to my (our) checking account indicated below and the depository (Bank) name below, hereinafter called DEPOSITORY (Bank), to debit the same to such account and if necessary, to make adjustments to the account for any entries made in error.

DEPOSITORY (Bank)
Name: ____________________________________________ Branch: ____________________________
City: ______________________________________ State: _________________ Zip: ________________

Transit/ABA Number:____________________________ Account Number: _________________________

Name(s) on account: ___________________________________ Telephone number: __________________
___________________________________

Signature(s): _________________________________________ Date:_______________________
___________________________________________ Date:________________________

Return completed form with a voided check (or copy of your voided check) to:

Cascade Communications Company
106 Taylor Street SE, PO Box 250
Cascade, IA 52033-0250