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Auto Credit/Debit Card Draft Authorization Form

Please simply complete and print this form. Then, you may either mail the signed and completed form to Gibson EMC, P. O. Box 47, Trenton, TN 38382 or deliver it to any one of our member service centers.

Your security code is the last three digits printed, not embossed, in the signature area on the back of a Visa, MasterCard, or Discover card and the last four digits printed, not embossed, on the front of an American Express card.
I hereby authorize my electric bill payments to be drafted monthly from the above named credit/debit card account. I understand that it will not be necessary for Gibson EMC or anyone employed by it to sign such drafts, and I agree that Gibson EMC's rights in respect to such drafts shall be the same as if issued and signed personally by me. I further agree that Gibson EMC shall be under no obligation to furnish me with any special advice or notice in writing or other wise of the presentment or payment of any such draft or the charging of the same to my account. This authorization is to remain in effect until revoked by me in writing, and until Gibson EMC actually receives such notice, I agree Gibson EMC shall be fully protected in honoring any such draft.
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