Nova Cable Customer, In response to many requests from customers, we are happy to introduce a new payment option that will automatically pay your Nova Cable bill from your credit or debit card account each month with no service charge. With Autopay you can: * Save time and money - it’s automatic and free * Avoid any lost or delayed checks in the mail * Have a safe and secure payment each month * Relax when traveling without worrying about bills * Avoid late fees and potential loss of service   Signing up is easy. Please complete the form below and send to: Nova Cable Management Inc. PO Box 793 Grand Haven, MI 49417 Enrollment forms received after the 15th of the month will be eligible for the following month’s Autopay plan. Accounts will be debited on the fifteenth of each month. Once you have enrolled, your monthly Nova Cable bill will state you are on Autopay. Thank you for your participation! Please complete the following form to begin Autopay.   PLEASE PRINT CLEARLY Nova Cable Customer Name________________________________ NOVA Account #_____________________________ Phone #___________________________ Card Holder (name on card if different than above)  ____________________________________________ Credit Card #________________________________  Expiration Date ___________________ Card Type (circle one): MasterCard   Visa   Discover   American Express Signature (required)____________________________________ Date ______________ I authorize Nova Cable Management, Inc., to charge the card or debit card listed above for monthly payment of my cable bill. I understand that it is my responsibility to inform Nova Cable of any changes (ie credit card #, expiration date, etc.) and that I may discontinue this service by calling 1-800-333-6682 For more information, call 1-800-333-6682 ----------------------------------------------------------------------------------------------- For office use only  Date entered: _________ By: _____________

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