AUTHORIZATION FOR AVERAGE MONTHLY PAYMENT (AMP)
I attest that my utility bill is current and I will continue to keep it current throughout enrollment in the Average Monthly Payment (AMP). I understand the amount billed is based on the most recent twelve-month average billing period; therefore, the monthly amount will vary slightly. I understand that I must have twelve months of service at my current address before I qualify for average billing. Failure to pay the amount billed by the due date will result in removal from the program and all balances are due in full at that time. I understand that I can enroll for the Average Monthly Payment (AMP) during the enrollment window of October, November and December and I also understand that I can terminate the Average Monthly Billing (AMP) at any time by signing and dating the AMP termination form. All balances are due in full when account is terminated.
AMP ENROLLMENTService Address: ________________________________________________________________________City: Granbury State: Texas Zip: __________________ Day Time Phone Number: ( __ __ __ ) __ __ __ - __ __ __ __ Drivers License Number: ____________________________________ for the state of: _______________Customer Signature: ____________________________________________________________________Date signed: Wednesday, November 26, 2008 Print this form and mail it to: Acton Municipal Utility District 6420 Lusk Branch Court Granbury, Texas 76049-2035
| FOR OFFICE USE ONLY: ___ Must be a Residential Customer ___ Minimum 12 Months billing history ___ Account balance is current ___ No Disconnects allowed within the last 12 months ___ No NSF checks allowed within the last 12 months ___ No more than 2 late payments within the last 12 month |
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