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Application for Assistance

BankDraft Program

*I (we) authorize DEMCO and the financial institution listed below to transfer (debit) money from the indicated checking account for payment of my electric bill.

I agree to the terms of this application:

Customer Name (as appears on bill):
First Name:	*
Middle Name:
Last Name:	*
Account Number:	*
Service Address:
Street Address:	*
City:	*
State:	*
Zip:	*
Email:	*
Mailing Address: My service address and mailing address is the same.
Street Address:	*
City:	*
State:	*
Zip:	*
Telephone Numbers:
Home Phone:	*
Work Phone:	*
Financial Institution Information:
Institution Name:	*
Street Address:
City:
State:
Zip:
Account Information:
Checking Account Number:	*
Routing / Transit Number:	*

DEMCO Headquarters
(225) 261-1221 or 1-800-262-0221

To report an outage
(225) 261-1160 or 1-800-262-1160

For billing and service information
(225) 261-1177 or 1-800-262-1170

Louisiana One Call
1-800-272-3020