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2. Description

   This program is a monthly set amount based on previous 12-month bill history. Failure to maintain a good payment history will result in removal from the program. Reconciles annually during the month of April at which time you will either need to pay the total variance due or determine what to do should you have a credit.

4. Date*
   Date
6. Account Number*
7. Email Address*
9. First Name*
10. Last Name*
12. Service Address*
14. City*
15. State*
16. Zip Code*
18. Phone Number*
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