City of Chappell

P.O. Box 487 - 757 2^nd Street Phone (308) 874-2401

Chappell, Nebraska 69129 Fax (308) 874-2508

BUDGET BILLING - UTILITIES

_____________________________

Date

Name Acct. #

_____________________________________________

Property Address

_______________________________________________________________

Monthly Billing Amount (average of Prior 12 months)

Participating in the Budget Billing Program does not mean that you are not responsible for the entire amount of your bill. It is your responsibility to watch the actual billing balance and make adjustments throughout the year as necessary should you be falling behind in your account. Any remaining billing balance at the end of December will be due in full with the January bill. All Budget Billing accounts will be re-calculated in January based on the average of the prior year’s usage. Regular budget payments are required each month by the due date or you will be removed from the program. The City of Chappell reserves the right to remove any resident from the budget billing program.

______________________________________

Signature

City Use Only

_________________________ _________________________

Budget Amount Start Date

__________________________

Date put in System