Budget Billing Agreement (SESD)
IN ORDER TO QUALIFY FOR THE BUDGET BILLING PLAN YOUR ACCOUNT MUST HAVE A ZERO BALANCE AT THE TIME OF ENTERING INTO THIS AGREEMENT.

I agree to pay *MONTHLY PAYMENT* per month towards *ACCOUNT NUMBER* on a budget billing plan. A late charge will not be charged on any balances past due, as long as the equal pay payment amount is made on or before the 20th of each month. Should the budgeted amount not be paid on or before the 20th of each month it will be considered a breach of contract; a late charge of 1.5% per month will be assessed on the outstanding delinquent balance (18% ANNUAL RATE) and your account will be removed from the Budget Billing program. Upon termination of the program, payment in full will be required if a delinquent balance is owing.

The monthly budget payment will be reviewed once a year on a calendar basis and revised if necessary. You will be notified if there should be a revised amount required.

PLEASE TAKE TIME TO REVIEW YOUR ACCOUNT MONTHLY. IT IS YOUR RESPONSIBILITY AS THE CUSTOMER TO MONITOR THE BALANCE OF YOUR ACCOUNT TO ENSURE THE MONTHLY BUDGET PAYMENT IS SUFFICIENTLY COVERING THE ACTUAL USAGE ON THE ACCOUNT.

SESD Account Number *
Your answer
Monthly Payment *
Your answer
Full Name *
Your answer
Phone *
Your answer
Email *
Your answer
Signature (type full name) *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service