SmartPay Budget 2015-2016
Sign me up for the SmartPay Budget Program, starting in
July - 11 monthly payments
Aug - 10 monthly payments
Sept - 9 monthly payments
D.F. Richard Account Number
Send me monthly statements.
Bill my credit card so I can pay automatically every month & get a 1-cent-per-gallon discount .
Set me up on your electronic funds transfer program & get a 3-cent-per-gallon discount.
If Paying by Credit Card
We accept MasterCard, Visa, or Discover
Name on Card
Credit Card Number
3-Digit Security Code
I have read and agree to the terms of agreement
If Setting Up Electronic Funds Transfer