| SimplePay Application and Agreement |
 Print, sign and return this to The Gas Company, along with an original voided check (no deposit slips, please). Or, if you wish to return it with your next gas bill payment, you do not need to enclose a voided check. If you do not have a printer, call us at (800) 427-2700 (with your account number handy) and we will mail you an application. Send to: |
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The Gas Company
Box 711-A
Los Angeles, CA 90051-1249 |
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Please select one of the following options:
X I want to sign up for SimplePay Direct Debit
-- I want to sign up for SimplePay by Net
-- I want to sign up for SimplePay by Phone |
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| Name (as it appears on your gas bill): | Zong B Chen |
| Service Address: |
11223 Mildred St. |
| City: |
El Monte |
| State: |
CA |
Zip Code: |
91731 |
| Daytime Phone Number: |
626-444-2803 |
| 11-Digit Gas Company Account Number: (as it appears on your gas bill) | 18651740005 | |
| E-mail Address (required for SimplePay by Net): | huan_mei2@hotmail.com |
| Financial Institution (required): | Cathay Bank |
Routing and Transit Number, plus Checking Account Number:
(all the numbers at the bottom of your check) |
122203950:16472567 |
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| I hereby apply to participate in the Southern California Gas Company SimplePay option checked on this form. When approved, this is my authorization to participate in this option as long as I meet the applicable requirements. I understand my participation in the option selected involves deduction from my checking account for payments of my gas bill. I confirm that I am responsible for paying any financial institution fees related to SimplePay transactions. I can end my participation in this option by notifying Southern California Gas Company. |
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Print Name (please print name as it appears on your gas bill: |
Zong B Chen |
| Signature (must match name on check): |
_____________________________ |
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| No | I would not like to receive periodic e-mails from The Gas Company about special promotions (you can stop receiving special promotions information at any time). |
If you have multiple accounts and would like to add them, please provide the service address and the gas account number on a separate request.
* Remember to either include an original voided check, or return the application with your gas payment.
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