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Electronic Funds Transfer (EFT) or (ACH) Origination Agreement

Authorization agreement for Direct Payments/Deposits

This authorization form allows your bank to send Glenwood Energy the funds to pay your gas bill. Funds will be transferred on the 20th of each month. If the 20th falls on a weekend or holiday then the funds will be transferred the following business day. If funds are not available at the time of the transfer, your bank will notify us and you that funds were not available and a non sufficient funds fee will be assessed to your account.

Company Name: Glenwood Energy of Oxford

I (we) hereby authorize Glenwood Energy of Oxford, Inc., hereinafter called company, to initiate credit/debit entries and to initiate, if necessary, adjustments for any credit/debit entries in error to my (our) Checking or Savings account indicated below and the depository names below, hereinafter called Depository, to credit/debit the same to such account. I (we) acknowledge that the origination of ACH transaction to my (our) account must comply with the provisions of U.S. law.

This authorization is to remain in full force and effect until Company has received written notification from me (us) of its termination in such time and in such manner as to afford Company and Depository a reasonable opportunity to act on it.

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Fax:   (513) 524-3409

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5181 College Corner Pike

Oxford, OH 45056

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Glenwood Energy is committed to providing access to important information via technology, including our web pages, for individuals with disabilities in accordance with Section 508 of the Rehabilitation Act. Section 508 requires us to ensure that individuals with disabilities seeking information or services from us, have access to and use of information and data that is comparable to the access and use by individuals without disabilities, unless an undue burden would be imposed on us. If you have a disability and the format of any material on our web pages interferes with your ability to access the information, please contact us at 513-523-2555 or postmaster@glenwoodenergy.com.  In order to help us respond in a manner most helpful to you, please indicate the nature of the accessibility problem, and the web address of the requested material so we can work together to ensure the information can be provided.