Wheat State's Special Edition 2019

Sign Up For Wheat State’s AutoPay Today! Enroll in AutoPay today and receive a coupon good for up to $95 off a High Speed Internet Gear Kit and Installation!* It’s beyond easy. Your Wheat State phone bill is paid every month–on time–by automatic withdrawals from your bank account. Safe, secure…and convenient. Just return this Authorization Agreement form and then sit back and relax. Got questions? Call us today at 1/800 442-6835. Cornerstone Group © 2019 Here’s how it works: • Your phone bill is mailed to you each month. • The amount due is deducted automatically from your bank account or charged to your credit card around the 10th of the month. • The amount deducted is shown on your bank or credit card statement. AUTHORIZATION AGREEMENT Name Address Phone Number (620) Wheat State Account # Choose one option:  Checking Account Auto Debit I (we) hereby authorize Wheat State Technologies, hereinafter called COMPANY, to initiate debit entries to my (our) checking account indicated and the depository named below, herein called DEPOSITORY, to debit same to such account. Your Financial Institution Name Date Routing Number Account Number Address City/State/Zip The authority is to remain in full force and effect until COMPANY and DEPOSITORY have received written notification from me (or either of us) of its termination in such time and manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on my request. PLEASE ATTACH A VOIDED CHECK REQUIRED FOR VERIFICATION. Signature  Credit Card Auto Charge Choose one:  VISA  MASTERCARD  DISCOVER  AMERICAN EXPRESS Credit Card # Expiration Date Signature Please return completed form to: Wheat State Technologies • P.O. Box 320 • Udall, Kansas 67146 Wheat State Technologies • 1/800 442-6835 • www.wheatstate.com *Coupon must be used within 30 days of enrollment in AutoPay. This coupon cannot be combined with any other special offers.