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Automatic Bank Draft Authorization

Simply complete and print this form. Then, please either mail the signed completed form along with a voided check (from the account you desire to be drafted) to Gibson EMC, P. O. Box 47, Trenton, TN 38382 or deliver the completed form and voided check to any one of our member service centers.

Please note: Pay-Go accounts are not eligible for Bank Draft payments.
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 otherwise 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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