ABC Payment Plan - Enrollment Form

Preferred Contact Method

Type of Account

Authorization Agreement for Preauthorized Payments
(checking the box to agree to the terms listed is required to continue)
I understand that by submitting this form, I authorize the financial institution (bank) named above to charge my savings/checking account to pay my monthly UGI utility bills. I agree that each charge to my account shall be the amount shown on my bill. I have the right to stop payment of a charge by calling UGI within 5 days of receiving my bill. If I stop payment 2 times in one year, UGI will take me off this plan. Also, I understand that both my bank and UGI reserve the right to end this payment plan and/or my enrollment in the plan. At any time, I may choose to be taken off this plan. If I so choose, I will give notice upon receipt of my bill to UGI Utilities, Inc.