Member InformationName(Required) First Last Company Email(Required) Phone(Required)Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Account Number(Required)(Click the + button to add a new row) Add RemoveBudget Billing Program Details Fixed Budget Bills are based on an annual average of your kilowatt hour use. Your bills are identical except during the adjustment month (February) when budget accounts are reviewed, and the catch-up month (August) when any difference between the billed and actual use for the previous twelve-month period will be billed or credited. Please read the Member Agreement & Consent below for additional program details.Member Agreement & ConsentMember Consent(Required) I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.All bills rendered by the Cooperative to the member will become payable under the same conditions as any standard billing. The current bill rendered will show, in addition to the Fixed bill, a previous balance forward showing any debits or credits, whichever may be applicable. Members must be at a zero balance prior to activating Budget Billing. Members must have 12 months of their own account usage history prior to activating Budget Billing. Failure on the part of the member to keep the account current may result in discontinuation of the Budget Billing plan to the member. If it is necessary to remove the account from the Budget Billing plan, any outstanding credit or debit will be applied to the next current billing. Penalties for late payment are assessed on the Budget Billing amount. Budget Billing accounts are subject to the same Terms & Conditions regarding disconnect for nonpayment as standard billing accounts. As such, the full balance due year-to date will be subject to collection. The member may withdraw from the Budget Billing plan by contacting the Cooperative to inform it of the member’s wishes. Any outstanding credit or debit will be applied to the next current bill. Any member choosing to withdraw from the Budget Billing plan shall remain out of the plan for 12 months before being allowed to reenter. The Cooperative reserves the right to set the initial budget payment at its discretion or to require a member to accumulate more history before starting the Budget Billing program. In the event the member’s account becomes over or underestimated, the Cooperative shall have the right to revise the budgeted amount for the succeeding month to bring the account into balance with actual rates and consumption amounts.Member Electronic Signature (Full Name)(Required) CommentsThis field is for validation purposes and should be left unchanged.
