Budget Billing Budget Billing Application First Middle Last Suffix Address Address 2 City/Town State/Province —Please choose an option—AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Account Number Email Address Contact Number I, the undersigned member(s) of Sequachee Valley Electric Cooperative, hereby request and make application to pay for my electric service by the BUDGET BILLING PLAN. Further, I understand and agree that the monthly payment that is to-be-determined by SVEC, will be reviewed at least semi-annually and necessary adjustments made as required due to changes in kWh consumption, rate schedule, fuel cost adjustments, etc. I further understand that after twelve (12) months, my account will “settle up”. As a result of the “settle up”, I will either owe the electric cooperative for any kWh that I have not paid for, or receive a credit for any kWh that I have overpaid. CONDITIONS OF THIS AGREEMENT This agreement is subject to cancellation at any time due to: Termination of electric service by the undersigned at the service location identified herein. Any late payment could result in being removed from the budget billing plan. Disconnection of service for non-payment of bill or any other violation of By-Laws or Schedule of rules and Regulations Thirty-days written notice by either party. Signature Sign above
