Send completed form to:
JEA
C/O Utility Collections Division
Customer Center, 3rd Floor
21 West Church Street
Jacksonville, FLorida 32202-3139

JEA EZ Pay
Authorization Form



Yes! Please sign me up for your EZ Pay Plan

Name:

JEA Service Address:

JEA Account Number:

Name of Financial Institution (Bank):

Bank Account Number:

Checking Account Savings Account

Daytime Telephone Number: ( ) - -


I hereby authorize JEA and my financial institution to process payment for my JEA account(s) on the monthly due date(s). I may cancel this authorization at any time by notifying JEA in writing 10 (ten) days before the due date on my bill. JEA may discontinue my participation in EZ Pay Plan at any time.
____________________________________________________________
Authorized Signature Date
 
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Joint Account Signature Date


IMPORTANT: Please attach a voided check or draft.