Autopay Application

Please complete the following form or download the Autopay Form (PDF) and return the completed form along with a “voided” check to:

Graham County Electric Cooperative, Inc.
Attention SurePay Program
PO Drawer B
Pima, AZ 85543

Questions? Call GCEC at (928) 485-2451.

Name of Bank(Required)

Location(Required)

Bank Account Number(Required)

Bank Account Holder Name(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Customer Number(Required)

(located on utility bill)

Member Name

(If different than Bank Account Holder Name)

First Last

Please attach a "voided" check(Required)

Max. file size: 300 MB.

Member Electronic Signature (Full Name)(Required)

This field is for validation purposes and should be left unchanged.