Levelized Billing Request Form

I, the undersigned member of Ouachita Electric Cooperative, Incorporated, do hereby apply for Levelized Billing as provided by policy number 3 of Ouachita Electric Cooperative, Incorporated.

I understand that my levelized amount shall be the average of my current month’s usage plus past 11 months actual usage. If service has been connected less than one year, my levelized amount shall be an average bill for the applicable rate class.

I understand that if my account is not paid in full by the bill due date on my statement, the account will become delinquent and will be removed from this program. If my account is removed from the Levelized Billing Program, I will not be eligible to reapply to the program for 12 months from date of removal.

If I withdraw from Levelized Billing, I shall have the option of paying the account balance in full, or, if qualified, make a delayed agreement. If my account has a net credit balance from withdrawal, the balance will be applied to my future billing or refunded to me within 30 days, upon written request.

I understand that it will not be necessary for me to reapply for Levelized Billing each year, and I will remain on Levelized Billing until such time as I request my account be removed.

- First Name *
- Last Name *

Street Address *

Other Address

- City *
- State/Province *
- Zip/Postal Code *

Email Address *

Account Number *

Levelized Billing Request Form