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* Please give us either ...

1. Your EONI Registration or PriorityONE Account Number

(skip to 2. if unknown)

or ...

2. Your billing contact information

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

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

* 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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