2. Please complete the information below to sign up for the Average Monthly Payment Plan.

   Please fill out THIS FORM if you are already enrolled in the Average Monthly Payment Plan and wish to be removed from this program.

4. ---
6. Full Name*
8. Customer - Account No.*
10. Phone No.*

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14. To be accepted for AMP, you must meet the following requirements: a. A residential customer at the same address for the previous 12 months.
    
    (Commercial customers are not eligible for this program)
    
    This agreement is extended with the understanding that all active and inactive accounts are to be kept in good standing on a monthly payment basis. If the account is not paid by the delinquent date and becomes subject to collection procedures, the customer will be removed from the Average Monthly Payment program and the total account will be due.
    
    If this agreement is canceled by the City of Edmond or if the customer withdraws from the plan, the customer will not be eligible to enter into another contract for average billing for one full calendar year and any monies owed within the plan will be due upon withdrawal.
    
    If a customer wishes to transfer service to another address in the Edmond area, they may do so. The current payment plan amount will transfer to the new account but will be monitored to insure the customer’s account remains within the Average Monthly Payment Plan Policy.
    
    If the account has a credit balance, this balance cannot be used for payment unless the customer withdraws from the plan.
    
    Accounts must be paid to a zero balance before the average billing plan can begin.
    
    I am authorized to make contractual obligations on behalf of this account.
    
    Type I AGREE in the authorization box below if you agree with the terms stated above.

16. Authorization*
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

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