NetOne Communications, Inc.

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electronic payment
We offer Electronic Account Debit for your convenience.   If you would like to take advantage of this payment method, please print and fill out the form below then mail or fax it back to us.

NEW! Fill out this form online at our secure forms site: click here

You may switch payment methods at anytime.   You also may choose to do a one-time debit to your account or have your account debited automatically.   Please feel free to contact us at 888-884-6381 if you have any questions concerning this new method of payment.   Please include a voided check with this form.

Our mailing address is: Our fax number is:
     NetOne Communications, Inc.
     2186 US 10
     Sears, MI  49679
DISCONTINUED - please email us at helpdesk@netonecom.net


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AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)


--------------------------------------------------------------------------------
Name ______________________________

Username __________________________

I (we) hereby authorize ___________________________________, hereinafter called NetOne Communications, Inc., to initiate debit entries to my (our) Checking Account / Savings Account (circle one) indicated below at the depository financial institution named below, and to debit the same to such account.   I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

Depository Name ___________________

Branch ____________________________

City ______________________________

State __________

Zip ____________

Routing Number ____________________

Account Number ____________________

This authorization is to remain in full force and effect until NetOne Communications, Inc. has received written notification from me (or either of us) of its termination in such time and in such manner as to afford NetOne Communications, Inc. and Depository a reasonable opportunity to act on it.
Name(s) ___________________________ Username __________________________
(Please Print)

Date_______________________________
Signature__________________________
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