Common use of On Account Clause in Contracts

On Account. This permission includes making changes, adding/removing services, disconnecting, making payments, receiving account balance information and answering Citizens' questions on my behalf. PTA must provide CPNI password, as set by primary account holder, in order to make changes or inquire about account. Primary account holder is assuming liability of changes made by PTA. Citizens has the right to refuse individuals who are in bad debt or delinquent status; SSN is required for this reason. Certain restrictions apply which may include credit credentials of PTA. Permission to Act*: (print) SSN First Middle Last SSN# Contact Number: Email Address ❏ Lifeline Credit Applicant: In order to be eligible for the discount, the applicant must participate in one of these programs or be Income Eligible: Medicaid, Food Stamps (SNAP), Supplemental Security Income (SSI), Federal Public Housing Assistance(FPHA), or Veterans Pension or Survivor Pension to receive Lifeline assistance. Additional forms must be completed for approval. Not available in all areas. Available in ILEC only. ❏ Enroll in Auto Pay: □ Accept □ Decline E-Bill (Receive bill via Email): □ Accept □ Decline