Direct Bank Draft

Simply fill out this form and either fax or bring a voided check along with the completed form by our office. Send faxes to: (423) 638-3140 NOTE: You will receive a bill as normal, but your payment will be automatically deducted from your account within two (2) days of the due date.


Note: The following form is in Adobe Acrobat format. You will need Adobe Acrobat Reader installed on your computer. This software is available FREE of charge and can found found at: