Payment Plan Application
In order to sign up for a payment plan, please print this document, and return the completed form to our Credit Department by fax, or mail to:
Credit Department
UPI Energy LP
105 Silvercreek Pkwy. N., Suite 200
Guelph, ON N1H 8M1
Fax: (519) 821-2618
Should you have any questions, please contact our Credit Department; toll free at 1-800-396-2667, or (519) 821-2667.
If choosing a Budget Payment Plan, please contact our Credit Department to inquire about your monthly budget payment amount.
UPI Account #: ________________________________________
Name: _______________________________________________
Address:________________________________________________________
City: _________________________________________________
Postal Code: ____________________________
Signature: ____________________________________________
Date: __________________________________
Please check the box next to the payment plan that you wish to sign up for:
Automatic Payment Plans
 Pre-Authorized Payments
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Any balance owing at the end of every month will be automatically debited in full from your bank account on the 20 day of the following
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month. For example, the balance owing on your March statement will be withdrawn from your bank account on April 20 . To sign up for this
feature, please complete the top portion of this form and forward it to our Credit Department with a VOID cheque.
 Pay by Credit Card (Some Conditions Apply)
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Any balance owing at the end of every month will automatically be billed to your credit card on the 20 day of the following month. PLEASE
COMPLETE THE CREDIT CARD INFORMATION SECTION BELOW.
Budget Payment Plans
Customers may sign up for Budget Payment Plans during the months of July, August, and September.
 Automatic Equal Payment Plan
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Your monthly budget amount* will be automatically withdrawn from your bank account on the 20 of each month, September to June
(inclusive). PLEASE REMIT A VOID CHEQUE WITH THIS FORM.
 Budget Cheque Plan
You may remit ten (10) post-dated cheques for your monthly budget amount*, one for each month from September to June (inclusive).
 Budget Plan by Credit Card (Some Conditions Apply)
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Your monthly budget amount* will be automatically charged to your credit card on the 20 of each month from September to June (inclusive).
PLEASE COMPLETE THE CREDIT CARD INFORMATION SECTION BELOW.
 Pre-Payment Plan
For added savings, you may pre-pay your entire pre-calculated budget amount* and receive a discount. Please remit your cheque in the
amount determined by your Account Representative with this form. If you prefer, we’ll charge your credit card. PLEASE COMPLETE THE CREDIT
CARD INFORMATION SECTION BELOW.
Credit Card Information
 Visa
 MasterCard
 American Express
 Diners Club
Cardholder Name: ________________________________________________
Credit Card Number: ______________________________________________
(as it appears on your credit card)
Expiry Date: ___________________
*IMPORTANT NOTE:
To inquire about your budget equal payment amount, please call our Credit Department. Final payment for all Budget Plans will be due in July. If you choose
either the Automatic Equal Payment Plan, or the Budget Plan by Credit Card, your final payment due in July will be automatically processed for you. To ensure
you do not have a high balance owing in July, please review your monthly statements for actual vs. budgeted balance, and call our Credit Department if you wish
to make a payment adjustment. All budget estimates include HST. The annual fee for SuperHeat PlusTM has been included where applicable.