Budget Billing Application

Enrollment for Budget Plans is year-round.
A zero balance on your account is required before the application will be processed.
A twelve month account history is used to determine budget requirements.
Monthly payments must be paid by the due date each month.
Bank Drafted accounts are debited the full amount owed upon settle-up in June or July. (Fixed Only)
If a refund applies, a credit will be issued to customer’s JCPB account
(Refund checks are available upon request during settle-up period)

There is a printable version of this form available. Printable Budget Billing Application

* Required

Residency Requirements:
I understand if I have not lived at this location for the past twelve months that my budget payments may not be accurate and I may owe a debit balance at budget year-end.	Yes *
JCPB Account Number:	*
First Name:	*
Last Name:	*
Email:	*Home:
Last 4 Digits of Primary Account Holder's Social Security Number:	*
Budget Options: Please select one.
Option 1: Rolling Budget Plan There is no settle-up month with Rolling Budget and amounts may vary slightly from month to month.
Option 2: Fixed Budget Plan The settle-up month for the Fixed Budget Plan will occur annually during June or July. Budget amounts will be re-evaluated upon settling-up.
Terms of Service: By submitting this form, I am in complete understanding of the Details of this agreement. Upon receipt of written notification, I understand this agreement may be cancelled by the JCPB or myself at any time (proper identification is required). I agree to pay the budget amount on or before the due date each billing period. If I fail to comply with this requirement, I understand my account will no longer qualify for Budget Plans and all unpaid balance will become due at that time.
I have read and agree to the Terms of Service as listed above and understand that this application must be processed by our CSA’s prior to acceptance.	Yes *