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 financial institution 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 (if different):______________________________

City:______________________ State:___________ Zip:_______

Day Phone:(____)______________________________________

Signature:_____________________________________________
THIS FORM CANNOT BE PROCESSED WITHOUT YOUR SIGNATURE

Name of Financial Institution:______________________________

ABA/Routing Number:___ ___ ___ ___-___ ___ ___ ___-___
(9 digits on bottom of check)

Checking Account Number:________________________________

Or Savings Account Number:______________________________

______ Only check if you want a copy of this form.

MAIL TO: ALPENA POWER COMPANY
P.O. BOX 188
ALPENA, MI 49707-0188

To insure the correct account number is used for this electronic payment and to obtain the ABA/Routing Number, please contact your financial institution.