Bank Deduct
Dear Subscriber:
You can have your telephone, cable, and Internet bill sent directly to your bank for payment. This convenient method saves you both time and a stamp while ensuring that your account with us is always current. You will still receive a monthly bill for your records. If you want us to set up automatic bank payments on  your account(s), please complete the form below. This authorization will remain in effect until Hamilton receives written notification to terminate.

Send completed form and a voided check to:
Hamilton Telecommunications
1001 12th Street
Aurora, NE 68818-2097
402-694-5101
(1-800-821-1831)

Bank Collection Authorization


Name of Financial Institution
Indicate Type of Account
Checking Savings


Bank Location
(City, State, Zip)


Account Number
(on check, bottom center)

Bank Transit Number
(on check, bottom left)

 I hereby authorize Hamilton Telecommunications Mid-State Community TV to collect payment of my bill from the above financial institution until such time as I cancel this arrangement. It is understood that in case of a billing error, an adjustment will be made between Hamilton Telecommunications or Mid-State Community TV and me.
*This bank collection authorization may be terminated by the customer at any time.


Customer Name


Customer Address


Customer Signature


Customer Telephone Number


Account Number on Bill


Date

Some financial institutions do not accept electronic withdrawals.
Each request will be verified with your bank.