Form Center

2. Please read all the rules before deciding if the budget plan is right for you.
   Your bill must be paid in full at the time of application. The Budget payment must be paid, in full, by the "Balance not paid by " date on your bill. Any partial payment or any payment missed, for whatever reason, may result in removal from the Budget Plan. Your account may be subject to disconnection if payments are not made by the due date. All leaks must be repaired promptly or you will be removed from the Budget Plan. Our computer system reviews and updates budget amounts every 6 months. The only notification that your Budget Plan amount has changed is the change in the amount due on your billing. We do not send letters to indicate your Budget amount has changed. You may, at any time, elect to be removed from the Budget Plan.
4. First Name
5. Last Name
7. Service Address
9. City
10. State
11. Zip Code
13. Account Number
15. Daytime Contact Phone Number
16. Home Phone Number
18. Email Address
20. Comments/Questions
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field