Name(Required) First Last Account Number(Required)Consent(Required) By submitting this form, I agree to the terms of the agreement.I, in the attempt to avoid experiencing possible hardship as a result of high winter season gas bills, request enrollment in your BUDGET PAYMENT plan. I have been a customer for the past twelve months. The amount of my BUDGET PAYMENT will be calculated by Southeast Gas based on my previous twelve-month billed amount and recalculated annually each subsequent year. This calculated payment amount must be paid monthly regardless of the balance showing on my account. I understand a credit balance may accumulate during the summer months. However, if any levelized payment is not paid by the due date, I also understand a late fee will be assessed on the BUDGET PAYMENT balance. I agree to be automatically removed from the BUDGET PAYMENT plan without notice if a late fee is assessed on my account. I understand that at least 12 months of billing history, no late fees during the last 12 months, and a zero balance on my account are all requirements of enrollment in this program. Participation in the plan is voluntary and renews automatically each year unless customer notifies the Southeast Gas to end participation. Any balance due at the termination of the plan is due in total at that point. By submitting this form I agree to the terms of this agreement.
