*Are you currently enrolled in eBill? (If you are, please log in to add an automatic payment)	YesNo
*CMP Account Number:
*Name:	(exactly as it appears on your bank statement)
*Street Address:	Apt:
*City:
*State:	Select a StateAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
*ZIP:
*Phone:
Alternate Phone:
E-mail:
Confirm e-mail:
................................................ Bank Information See a sample check below. If you prefer to send a voided check, follow the instructions at the end of this form.
*What type of account would you like to pay from?	Checking Savings
*9-Digit Routing Number:
*Bank Account Number:
*Re-enter your Bank Account Number:
*Name of your Bank:
Payment Information
When would you like your payment to be withdrawn? (The actual date your payment is withdrawn could vary by a few days from month to month.)	Please choose from the dropdown menu: When my bill arrives4 days before the due date5 days before the due date6 days before the due date7 days before the due date8 days before the due date9 days before the due date10 days before the due date11 days before the due date12 days before the due date13 days before the due date14 days before the due date15 days before the due date16 days before the due date17 days before the due date18 days before the due date19 days before the due date20 days before the due date21 days before the due date22 days before the due date23 days before the due date
................................................ Authorization  I (we) hereby authorize Central Maine Power Company, hereinafter 'CMP,' to make electronic entries to my (our) checking or savings account indicated below and the depository named below, hereinafter 'Depository', to settle the same to such account. This authority will remain in effect until CMP or Depository has received written or verbal notification from me (or either of us) of its termination in time and in a manner so CMP or Depository has a reasonable opportunity to act on it. I (we) hereby agree that I (we) have read and understand the terms and conditions of the program.
CMP Account Holder Signature:	Date:
Bank Account Holder Signature (if different than above):	Date: