Credit Card Draft Authorization

Please complete the form below, print and fax to: 770-683-3884
You may also mail to our office: Newnan Utilities Customer Service, 70 Sewell Road, Newnan, GA 30263

Customer Name:

Street Address:

City:

State: Zip:

Phone:

Newnan Utilities Account #

-

I authorize Newnan Utilities to draft my credit card account on a monthly basis for the full amount of my utility bill. My credit card account will be drafted two days before the due date printed on my bill.

Credit Card:

MasterCard    Visa

Credit Card Number:

Expiration: January February March April May June July August September October November December 2008 2009 2010 2011 2012 2013 2014

Signature