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Habersham Electric Membership Corporation > Billing > Payment Extension Proposal Form

Payment Extension Proposal Form

Name*
First Last
Account Number
Meter Number
Day Phone*
Evening Phone
Cell Phone
Email Address
Service Address
Street Address Address Line 2 City State ZIP Code
Bill Due Date*
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 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.
Name
This field is for validation purposes and should be left unchanged.

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