Registration Form

Print out this form.  Fill out the information and mail to Kittitas PUD, 1400  Vantage Highway, Ellensburg, WA 98926

Name:_________________________ Kittitas PUD Account #:___________________

Phone:________________________ Email: _______________________

___ Option 1: Yes! I will use Click 2 Pay or Phone 2 Pay to enter my monthly meter reading and pay my monthly electric bill from my bank account's electronic funds transfer. (include a voided check or savings deposit slip with this signed registration form)

Bank Account #:_________________________ 9 Digit Bank Routing# _ _ _ _ _ _ _ _ _

___ Option 2: Yes! I will use Click2 Pay or Phone 2 Pay.   If I chose Option 1 above, I authorize Kittitas PUD to charge my bank account monthly for the payment amount I indicate using the Click 2 Pay or Phone 2 Pay billing and payment services.

Signature_________________________ Date_____________________