Return This Form to ARKANSAS OKLAHOMA GAS CORPORATION

Authorization for Automated Bank Draft

Return this form to ARKANSAS OKLAHOMA GAS CORPORATION.

For additional information, call: 479-784-2000 or 1-800-842-5690 or FAX # 479-782-1881

NAME:

ADDRESS:

CITY: ZIP: PHONE:

CUSTOMER ACCOUNT NUMBER:

►FINANCIAL INSTITUTION:______

►CITY: ______►STATE:______

►CHECKING OR SAVINGS ACCOUNT NUMBER: ______

►ROUTING #______

***PLEASE ATTACH VOIDED CHECK***

I authorize you to charge my checking or savings account monthly in the amount of my monthly gas bill and to make that deduction payable to Arkansas Oklahoma Gas Corporation. In making this authorization, I agree to the Terms and Conditions of Authorization.

►DATE:______►SIGNATURE:______

(Name Authorized on Checking or Savings Account)

------

RETAIN FOR YOUR RECORDS

For your records:

on______

(date)

I authorized______

(Name of Financial Institution)

to pay and to charge my account the amount of any instrument drawn on my account by and payable to the order of:

Arkansas Oklahoma Gas Corporation
115 N 12th Street·PO Box 2414

Fort SmithAR72902-2414

Customer Service: 479-784-2000 or 1-800-842-5690

NATURAL GAS – “The Environmental ProtectionEnergy”

Save Time & Money…

With Automated Bank Draft

AOG is offering you a more convenient way to pay your natural gas bills.
It’s called Automated Bank Draft.
Automated Bank Draft (ABD) allows you to pay your bills automatically by charging them to your checking or savings account.
Automated Bank Draft is the
Most Convenient
Dependable
Lease Expensive
way to pay your
monthly gas bills.
· You save time by not having to write
checks for your bills.
· You save money on postage and
bill paying supplies.
· You no longer have to worry about
your payments being lost, or about
not being able to pay your bills
when you are out of town on
business or vacation. / Enrollment is Easy
Simply complete the authorization form on the reverse side and you can stop writing checks for your monthly gas bills.
Please allow 30 to 60 days for your ABD application to become effective.
How ABD Works
You will continue to receive your monthly gas bill statement. It will have the notification: Bank Draft, Do Not Pay.You will know the exact amount and date of your payment and when it will be deducted from your bank account.
If there are any questions regarding your bill, please call Arkansas Oklahoma Gas and resolve your concerns at least one week before your bank account is drafted.
If the bill is correct, the amount specified will be deducted from your account on the date specified… no need to write a check or spend money on postage.
Payment information will be shown on your monthly bank statement.

Natural Gas “The Environmental Protection Energy”

TERMS AND CONDITIONS OF AUTHORIZATION

1. AUTHORIZATION:
Review the Authorization
Agreement or call AOG for
details. Complete the
Authorization Agreement for
the automated bank draft
program if you choose to
participate. Each payment
shall be the same as if it
were an instrument
personally signed by you. / 2. REVOCATION:
This authority is to remain in
effect until revoked by
either the customer,
company or financial
institution.
Customer must notify AOG
to discontinue automated
bank draft service at least
one week before your
account is to be drafted. / 3. STOP PAYMENT
You have the right to stop
payment of a charge by
notifying your financial
institution up to seven (7)
business days prior to the
charging of your account.

NOTE: To ensure accurate account information, please enclose a voided check or deposit slip with your authorization form.

(See Reverse Side)

Stop Writing Checks For Your Monthly Bills…