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If you would rather print a form, it is located here.  You can send the completed form through e-mail, mail or drop it off at the office.

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 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.

Bank Information

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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