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1� <br /> DEC-15-2006 FRI 09�57 AM CITY OF DECATUR FINANCE FAX N0, 2174242717 P. 07 <br /> ��� <br /> Account Agent Des➢gnat�on Sta�etnent <br /> This statement will confirm that effectiv.e {Date), ���!di pe����UStom�1') ha�er►tered <br /> inko an agt'eement w9th and has designated �Agent) as hi�/h�rJits A�ent for <br /> the purpose of arranging and making all d�cisions rag�rding s�rvice on his/her/its b�halF�egarding sen►Ice <br /> for the Amerert Account Number(s) Ifst�d belnw. <br /> The agent is�uthorized to m�k�decistons regarding this�ccount(s). Am�ren may reiy on any <br /> representatilon made by Ag�nt regarding thls account(s) and heed not queskion the authority of the Agent <br /> to act on the Custome�'s beh�lf. Ameren sh�ll nat b� liable far any ackion taken In response tn a <br /> on he Custom�r's behalf,�nclud ng any actlon"taken by th��Campa y at�he Ag nt's equest r���s agent <br /> Ameren will continue to communi�aXe direckly with the Customer dn matters reldted ko connection ahd <br /> discnnne�ion of service and credit fssues. <br /> Cu�tomsr Nam� {please print): <br /> Custamer Signature: <br /> Dat�: � <br /> Cu�"k�mcr Gontact xl�►forrr�a�ion A�en!Conta�C InfArmation <br /> Address: �� Addressc w.Wa n h�d 300 <br /> baeatur..IL fi�S2� C e n 06 � <br /> Phone: � Phone: 312 70 ��,920i1 <br /> Fax: 312 7 -8530 <br /> _ o ced b Ame� <br /> en shauld <br /> Statement Che bi11 pr dU Y <br /> Upon the effective d�te af thls Account Agent Deslgnat�on , <br /> be sent Xo (please choase one); <br /> ������@�, p���t{pkease specify mafting informatipn below) <br /> Name: <br /> Attention: <br /> Address: <br /> 'Thls Account Agent Qesigflatfon St�tement will applY tn the ar.caunt numbers listed beloav. Please li�t one <br /> me�er numf�r assacfated with ea� accounC. Attach additional page !f necessary: I <br /> Aq�unl NeimbAl' Nel�r Nterlber il <br /> �77 4Tl(q79B <br /> � 2� <br /> � Revlsed 10-2�05 <br /> PAGE 1f11�RCYQ AT 12f151200616:�0:28 AM�Eastem Standartl TimeJ�SVR:RFXBRD-0MF�D1l1"DNIS,B948"CSIQ,21T4242111�DUR�TIDN(mm•ss):06•3D <br />