Simplify your life with Laclede's
Easy-Pay direct payment plan.

Follow these easy steps to sign up:

1.	Type your information into the electronic form. Use your 10-digit gas bill account number, which is located on the top left portion of your gas bill. Once completed, right click on the electronic form and select the “Print” option. Once printed, sign the form.
2.	Mail the enrollment form with your payment and bill coupon using a check from the same bank account you want to use for Easy-Pay or send a voided check from any bank account you want to use for Easy-Pay.
3.	Record your enrollment information at the bottom of this form, detach and keep for your records.

Yes, I want to participate in the Easy-Pay direct payment plan. I authorize Laclede Gas to debit my checking or savings account each month for my gas bill payment.

Gas bill account number:	--
Name
Address
City/ZIP
Daytime Phone
I want to sign up for automatic giving to Dollar-Help at this amount per month:	$
Signature
Date

Return this form to:
Laclede Gas Easy-Pay
Drawer 9, St. Louis, MO 63166

I authorized Laclede to automatically deduct funds each month
on the due date of my gas bill from my . . .

checking account at savings account at

(bank/credit union)

I also added $ to my monthly gas bill as a donation to Dollar-Help.