Eastern Oregon Net, Inc.
The Internet Done Right

Your information is private and secure using EONI's SSL server to encrypt all data during transmission.

The Automated Clearing House (ACH) is a nationwide electronic funds transfer (EFT) system that facilitates the inter-bank clearing of credit and debit transactions and information exchanges among participating financial institutions.

THIS FORM APPLIES TO YOU ONLY IF:

• you are currently on a MONTHLY billing cycle, or you wish to change to MONTHLY billing, and
• you want to update your existing ACH agreement with EONI to reflect a change in your bank, your bank account or other record details, or
• you need to establish an ACH agreement with EONI because you are either converting from a different payment method (such as credit card) or you have not yet established an agreement because you signed up by telephone or some means other than the online signup

Please give us either ...

1. Your EONI Registration Number

(skip to 2. if unknown)

or ...

2. Your billing contact information

First Name:
Last Name:
Billing Address:
City/State/Zip:

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Now, refer to one of your checks or deposit slips (see the sample depiction below) and complete the rest of this form!

* = REQUIRED

* Type: checking savings
* Bank: (name of your bank)
* City: (where is your bank?)
* State / Zip:
* Transit/ABA: (AKA bank routing number)
* Number: (bank account number)
* Your Name: (as recorded by your bank)

Finally, choose the day of the month you want us to process your automatic ACH payment.

* Day of Month: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (preferred day of month)

I hereby authorize Eastern Oregon Net, Inc. to initiate debit entries to my account indicated above, and hereby authorize the BANK DEPOSITORY named above to debit the same to such account. This authorization is to remain in full force and effect until Eastern Oregon Net, Inc., has received written notification from me of authorization termination (or Notification by Eastern Oregon Net, Inc., of account termination, in such time and and in such manner to afford Eastern Oregon Net, Inc., a reasonable opportunity to act upon it.
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