Within three (3) working days, I will furnish to Montezuma Utilities a satisfactory twelve (12) month payment history. (No disconnection for non-payment and /or no more than 3 late/disconnect notices) within the last two (2) years. An additional deposit is required if no satisfactory payment history.

Failure to provide the history requested will result is disconnection. Bills are mailed on the 1^st of each month, due by the 20^th of each month. Bills not paid by the 20^th will be assessed a penalty. Disconnection for non-payment will occur fourteen (14) days after the 20^th.

I understand the billing, payment and disconnection dates and certify the above information to be true and correct. I have received Customer responsibility information concerning maintenance of gas appliances and service lines