BUDGET BILLING APPLICATION

Account Holder Name: Account Holder Name: * First Last
Service Address: Service Address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Account Number *
Phone: Phone: * - ### - ### ####
Email: *
Budget Billing helps you manage your utility costs by averaging your usage over the previous 12 months. This provides a
more predictable monthly payment. Please review the following important details:

● Eligibility: I must be a Starkville Utilities customer for one year before enrolling in Budget Billing.

● Minimum Enrollment: I must be enrolled in Budget Billing for a minimum of one year.

● Account Status: My account must be current (not past due) to be eligible for Budget Billing. If my account is not
current, it will be removed from Budget Billing.

● Payment Amount: My initial budget amount will be based on my average monthly usage over the past 12
months, plus any applicable associated charges.

● Responsibility for Balance: I am responsible for paying any accrued balance that exceeds the budgeted amount.

● Credit Balance: If a credit balance exists after six months, it will be applied to the following bill.

By signing below, I am requesting that Starkville Utilities place my account on Budget Billing and acknowledge that I have
read and understand the terms outlined above.
Customer Signature *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date: Date: * / MM / DD YYYY
Important!!! To help you manage your account, you will be automatically enrolled to receive alerts and reminders via text
message and/or email for due dates, past due amounts, account profile changes, payment confirmations, and returned
checks. You will typically receive notifications five days prior to the due date and for past-due amounts. Standard
message and data rates may apply.
Starkville Utilities Personnel Only:
ACCT#
CSR:

BUDGET BILLING APPLICATION

BUDGET BILLING APPLICATION

Starkville Utilities Personnel Only: