NACHA Form

Automatic Monthly Direct Payment Form

for Checking or Savings Account
(Account must be up-to-date to use this feature)

*RMLD account number:

*Customer name:

*Address:

*City, State and ZIP:
(Please choose one)

*Contact phone:

E-mail address:

SSN or MA drivers license number:

Your banking information

*ABA number: Checking account only, nine digits required

*Account number:

Checking Savings

*Required information

By submitting this form, I authorize my financial institution to deduct the amount of my monthly RMLD electric bill from my bank account on my discount day.

I understand that I am in full control of my payment, and if at any time I decide to discontinue the Automatic Monthly Direct Payment option, I will notify RMLD.

RMLD and my financial institution reserve the right to terminate this payment option, at which time I will be notified in writing.

Customer's participation is subject to RMLD's approval.

If you prefer, you may print and complete this form and mail it with a VOIDED check to:

RMLD

Automatic Monthly Direct Payment
P.O. Box 150
Reading, MA 01867

Submitting the form

Please print a copy of this form for your records.

After submitting the form, you will receive confirmation from the Customer Service Department by return e-mail or phone call. You will also receive a letter that your account has been set up for this Program with further details.

If you have any questions or need more information about this Program, please call Customer Service at 781-944-1340. Our business hours are Monday through Friday 8:00 a.m. to 4:30 p.m.

for Checking or Savings Account (Account must be up-to-date to use this feature)
*RMLD account number:
*Customer name:
*Address:
*City, State and ZIP: (Please choose one)
*Contact phone:
E-mail address:
SSN or MA drivers license number:
Your banking information
*ABA number:	Checking account only, nine digits required
*Account number:
Checking Savings
*Required information
	By submitting this form, I authorize my financial institution to deduct the amount of my monthly RMLD electric bill from my bank account on my discount day. I understand that I am in full control of my payment, and if at any time I decide to discontinue the Automatic Monthly Direct Payment option, I will notify RMLD. RMLD and my financial institution reserve the right to terminate this payment option, at which time I will be notified in writing. Customer's participation is subject to RMLD's approval. If you prefer, you may print and complete this form and mail it with a VOIDED check to: RMLD Automatic Monthly Direct Payment P.O. Box 150 Reading, MA 01867 Submitting the form Please print a copy of this form for your records. After submitting the form, you will receive confirmation from the Customer Service Department by return e-mail or phone call. You will also receive a letter that your account has been set up for this Program with further details. If you have any questions or need more information about this Program, please call Customer Service at 781-944-1340. Our business hours are Monday through Friday 8:00 a.m. to 4:30 p.m.