You can add a dollar or more to your electric bill each month to help pay electric bills for the needy citizens of Maury County. Thank you for your involvement in helping your neighbors and community.

Last year, customers gave over $15,000 to the Plus One Program. Good Samaritans used this money to assist families with their utility bills.

I/we do hereby authorize and empower CPWS to increase my electric bill by the sum marked below per month to help pay electric bills for the needy citizens of Maury County. This amount and all sums collected pursuant to the Plus One Program will be paid into a fund to be administered by the Good Samaritans of Maury County for the purpose set forth above.

This authorization obligates me to pay the additional sum per month until such time as I deliver to CPWS a written request that this obligation be terminated. Upon receipt of said written request, CPWS will terminate my Plus One Program participation as of the next regular billing cycle, and I/we will no longer be obligated to make said payments.

Address: ____________________________________________________________________

Account number: ____________________________________________________________

Signature: ____________________________________________ Date: ________________