Payment Extension Proposal

Name
Account Number
Meter Number
Day Phone #
Evening Phone #
Cell Phone #
Email
Service Address
Due Date of Current Bill
Proposed Payments

This proposal is subject to review and approval by the Habersham EMC Member Services Department. In no way does the submission of this completed form guarantee that the proposed extension will prevent disconnection of electric service. Please be sure to fill in all the blanks so that Member Services personnel may contact you. You will be notified if the proposed arrangement is acceptable or not.