Bardstown Internet

BARDSTOWN INTERNET AUTOMATIC MONTHLY BANK DRAFT

AUTHORIZATION FORM

In order to use the automatic bank draft option we need you to fill out this form below, or click here for a printable form.

Your Name:
Phone Number:
Street Address:
City:
State:
Zip:
BISI Account Number::
Your Current Email Address:
Questions or Comments:
Bank name:
Routing Number (9 digits):
Account Number:
Amount to be drafted:
*NOTE: YOUR BANK STATEMENT WILL SHOW A DEBIT TO BISI.*

I authorize Bardstown Internet Service, Inc. to deduct the monthly rate from my checking account on the 1st or 15th (check one) day of each month beginning on the day of 20 .

**When closing your account with Bardstown Internet Service, Inc. it is your responsibility to notify our office that you wish to stop bank draft at least five business days prior to your next billing cycle.**

CONTACT US
Send your questions, suggestions or comments to info@bardstown.com or give us a call at
349-9444. For comments or suggestions about this web page, email Webmaster.