BONNEVILLE POWER ADMINISTRATION
Direct Debit Form
For more information:
[email protected] or 503-230-5788
Updated March 2019
OFFICIAL USE ONLY
BPA F 2240.02e
(09-17)
U.S. DEPARTMENT OF ENERGY
BONNEVILLE POWER ADMINISTRATION
Electronic Form Approved
by Forms Mgmt –09/15/2017
AUTHORIZATION AGREEMENT FOR BPA’s DIRECT DEBIT PAYMENT PLAN
Privacy Act Statement
Authority: 42 U.S.C. § 7101 et seq; 50 U.S.C. § 2401 et seq.
Purpose: BPA will use this information to collect automatic payments from the financial institution account listed on the form.
Routine Uses: We do not disclose your information to third parties without your consent, except to fulfill the purpose for collection or as legally required.
Records may be disclosed to: BPA employees and contractors as required to complete job duties; to necessary parties if the security or confidentiality of
the information in the records is compromised; and to the Department of Energy and other agencies to investigate potential violations of law, and as
necessary to minimize harm when information security has been compromised. Additional potential disclosures are listed in Privacy Act System of
Records Notice DOE-18, Financial Accounting Systems, available at www.BPA.gov.
Disclosure: Providing information on this form is voluntary. Failure to do so will require you to make individual payments to BPA, rather than having
them deducted automatically from an account.
INDIVIDUAL/COMPANY INFORMATION
INDIVIDUAL/ORGANIZATION NAME: (Please print/type)
CONTACT NAME: (Please provide if organization is applying)
STREET ADDRESS:
CITY/STATE:
ZIP CODE:
TELEPHONE NUMBER:
AREA CODE:
E-MAIL ADDRESS:
I hereby authorize the initiation of a deduction from my account and the financial institution named below to debit such
account. I understand I will be notified if the debit amount needs to be adjusted, either to be increased or decreased. I
also understand that I have the right to stop automatic payment by notifying my financial institution in writing three days
prior to the time my account is charged.
SIGNATURE: DATE:
FINANCIAL INSTITUTION INFORMATION
FINANCIAL INSTITUTION NAME:
STREET ADDRESS:
CITY/STATE: ZIP CODE:
NINE – DIGIT ROUTING TRANSIT NUMBER:
ACCOUNT NUMBER:
CHECKING
BUSINESS ACCOUNT
SAVINGS
PERSONAL ACCOUNT
BILLS TO BE PAID THROUGH THE DD PAYMENT PLAN:
TRANSMISSION/POWER BILLS ONLY
ALL BILL TYPES
What is the Direct Debit Payment Plan?
The Direct Debit (DD) Payment Plan is an electronic payment option, which authorizes the Bonneville Power Administration
(BPA) to automatically withdraw payments to BPA from a customer’s bank account. This option is an alternative to wire transfers,
automated clearing-house (ACH) credits, and paper checks.
What are the benets of enrolling in the Direct Debit Payment Plan?
It is free
— Financial institutions may charge for wire transfers and ACH credits.
It saves time and resources
— Customer do not have to initiate payment.
No late payments
— Customers will never have to worry about making a payment on time or missing an invoice.
On what day will my bank account be debited and for how much?
Customers will continue to receive bills from BPA, either via email or the Customer Portal. For amounts owed to BPA,
accounts will be debited on the invoice due date for the amount indicated on the bill.
How do I set up this service?
Send your completed Authorization Agreement to BPA by mail, email, or fax.
MAIL: Bonneville Power Administration
Attn: Accounts Receivable – FTOA-2
P.O. Box 3621
Portland, OR 97208-3621
EMAIL: [email protected]
FAX: 503-230-4690
Questions?
Email [email protected] or call 503-230-5788
BONNEVILLE POWER ADMINISTRATION
Direct Debit Instructions
Updated March 2019
