SC1091i (06/29/2017) (FS)
Name on Account:
Zip:State:
City:
Address:
E-mail:
Would you like to receive information on programs
and services Santee Cooper offers via e-mail/mail?
Yes
No
Mailing
Address:
Select: » »
Checking (include voided check)
Savings Account
Type of Bank Account: (select only one)
I (We) hereby authorize Santee Cooper to place my (our) payment
for the monthly electric bill on
(Select only one of the following choices):
Budget Billing
Auto Pay Billing
1. Be a residential customer for 12 months
2. Not have arrears
3. Not have missed more than one payment during the past 12 months
4. Not have issued a bad draft/check to Santee Cooper during the past 12 months
5. Not have been removed from Budget Billing during the past 12 months
Budget Billing Information:
(customer qualifications)
Electric Account No.:
Auto Pay Information:
Social Security No.:
Bank Account No.:Bank Transit/ABA No.:
Branch:Bank Name:
Zip:State:City:
Bank Address:
Monthly Budget Payment:
To Be Completed By Santee Cooper
Application
Prepared By:
Date:
Customer
Signature:
Note: If your monthly electric bill exceeds your
maximum auto pay amount, your account will
be drafted for the maximum amount and YOU
will be responsible for the balance due.
Maximum Auto Pay Amount:
Day Phone:
APPLICATION FOR BILLING
BUDGET AND AUTO PAY
Country:
Street/P.O. Box:
Santee Cooper Identification No. 57-6000917
Street/P.O. Box:
