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. 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.