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Please print, complete form, and return signed form (with original signature) to Alpena Power Company.
For your convenience, this enrollment form is also printed on the back of your monthly Alpena Power Company statement.
I authorize Alpena Power Company to charge or deduct my payment(s) for the account number listed below to the credit card company identified below.
I understand that I control my payments and if at any time I decide to discontinue this payment service I will notify APC at least five (5) days before the payment is due.
Name (as shown on your bill):_______________________________________
Service Address_________________________City/State/Zip______________
Mailing Address__________________________City/State/Zip______________
Day Phone:(____)________________________________________________
Name of Credit Card Company:_______________________________________
Credit Card Account Number: ___________________Expiration Date ___ /___
[ ] Deduct my payment monthly from my credit card on a regular basis.
[ ] Only deduct my payment for the date of ______ from my credit card.
Signature:_______________________________________________________
This form cannot be processed without your signature.
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