Green Bay Gas: Budget Payment Plan Application

BUDGET PAYMENT PLAN APPLICATION:

• Budget Payment Plans may be started at any time during the year.

• To qualify for the Budget Payment Plan you cannot have an unpaid account balance and your propane tank must be at no less than 50% of its capacity.

• Payment amounts are determined by Green Bay Gas. The Budget Payment Plan monthly amount is based upon your previous year's propane consumption in gallons, multiplied by the current Discount for Cash price per gallon, divided by 12 months. New accounts with no purchase history are estimated.

• Budget Payment Plans are reviewed bimonthly and subject to change. Any changes that may have occurred in the Discount for Cash price will be reflected in a modification to your Budget Payment Plan amount. ln example, an increase or decrease in the Discount for Cash propane price will result in your payment amount being increased or decreased accordingly.

• Budget Payment Plan accounts are not subject to finance charges on any unpaid account balances. Deliveries made to Budget Payment Plan customers are invoiced at Green Bay Gas's current Discount for Cash price in effect on the date of your propane delivery.

• Budget Payment Plan amounts are due in full before the 15th of the month. Any payment amount remaining unpaid at the end of the month is considered past due. Past due amounts will necessitate your removal from the Budget Payment Plan. Accounts removed from the Budget Payment Plan become subject to Discount for Cash delivery terms.

Please print, sign and return this form to Green Bay Gas. Retain the upper portion for your records.

Name:	______________________________
Delivery Address:	___________________________________ ___________________________________ ___________________________________
Customer Signature:	___________________________________
Date:	___________________________________

Please print and send completed form to:
Green Bay Gas

•	Budget Payment Plans may be started at any time during the year.
•	To qualify for the Budget Payment Plan you cannot have an unpaid account balance and your propane tank must be at no less than 50% of its capacity.
•	Payment amounts are determined by Green Bay Gas. The Budget Payment Plan monthly amount is based upon your previous year's propane consumption in gallons, multiplied by the current Discount for Cash price per gallon, divided by 12 months. New accounts with no purchase history are estimated.
•	Budget Payment Plans are reviewed bimonthly and subject to change. Any changes that may have occurred in the Discount for Cash price will be reflected in a modification to your Budget Payment Plan amount. ln example, an increase or decrease in the Discount for Cash propane price will result in your payment amount being increased or decreased accordingly.
•	Budget Payment Plan accounts are not subject to finance charges on any unpaid account balances. Deliveries made to Budget Payment Plan customers are invoiced at Green Bay Gas's current Discount for Cash price in effect on the date of your propane delivery.
•	Budget Payment Plan amounts are due in full before the 15th of the month. Any payment amount remaining unpaid at the end of the month is considered past due. Past due amounts will necessitate your removal from the Budget Payment Plan. Accounts removed from the Budget Payment Plan become subject to Discount for Cash delivery terms.