5.5. ERMUSR 03-09-2010 - Laserfiche WebLink

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ELK RIVER MUNICIPAL UTILITIES APPLICATION FOR BUDGET PLAN I hereby request that my utility account with Elk River Municipal Utilities (ERMU), Elk River, MN, for the address listed below, be placed on the Budget Payment Plan. Pursuant to the Budget Payment Plan, I agree to pay ERMU, on the 15th day of each month, an amount equal to 1/12th of my anticipated annual billings. I understand that this amount may be adjusted at the discretion of ERMU, if my average monthly billings exceed the anticipated amount and an adjustment is therefore warranted. I agree that my account will be reconciled with the December billing each year. All unpaid balances will be due and payable by December 15th of each year. If the total of all payments received during the year exceeds the total amount due, the excess will be credited to the December billing. I agree to pay $xxx.xx on the 15th day of each month, subject to adjustment as set forth above. I understand my Budget Payment Plan year begins with the bill due XXXXX 15th, 2010 and ends with the bill due December 15, 2010 and is subject to a reconciliation on December 15th as provided above. I understand that participation in the Budge Payment Plan requires participation in Automatic Bill Payment. I further understand that if I fail to meet the above payment requirements because of an NSF payment, this will result in cancellation of my Budget Payment Plan and Automatic Bill Payment. Your aaourn mrst F~ paid cu»~nt prior to this agru?rrer~ for;uars application to l~ acr~ta~ Account Holder Account Address Elk River, MN 55330 NO, I do not wish to sign up for the budget plan at this time. Account Holder Date Date TO QUALIFYFOR THE ABOVE PAYMENT SCHEDULE PLEASE COMPLETE THIS FORM AND RETURN TO ERMUBY