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812-654-2444 Phone

812-654-3834 Fax

800-379-1800 Emergency

Budget Billing Sign-up
Deadline to sign up is June 17, 2017.

Name:
Street Address:
Account Number:
Phone Number:
E-Mail Address:
I would like to participate in the Budget Billing Program.

AGREEMENT
I understand the terms of the Budget Billing Program and calculation of the established monthly payment amount and do hereby agree to pay the established monthly payment on or before the due date per my monthly natural gas bill. I understand that this Agreement shall remain in effect until I advise the Gas Co. to terminate my participation in the Program, or the Gas Co. terminates my participation in the Program. Upon termination from the program; any balance shall be due immediately and may be subject to disconnection and any credit balance on my account will be applied to my next monthly bill or refunded according to standard company policy.

Signature:
(Type your name above to signify your signature and indicate your
acceptance of the terms and conditions of the program.)