Apply for a Payment Plan Arrangement Online

Date of Request:

Account Type: 
Utility Account #: 
Name:

Mailing Address:

Service Address:

Phone:

Email:

Reason Unable to Pay:  COVID- 19 Related    Not COVID-19 Related
I am unable to pay my full water bill due to: 
If reason unable to pay is "other," please specify: 
Payment Plan Requested: A Payment arrangement is a plan to pay the current bill charge plus the previous balance in monthly installments. (12 Month Maximum)
I am Requesting that Utility Office accept a Total Monthly Payment of:
$ beginning (Date)  for  months.

Important Information:
You will be notified by customer service regarding this matter once approved. You will continue to be billed each month. We encourage you to make regular payments. A late or missed payment will cause your agreement to go into default. Once in default, the entire past due balance will become due or service disconnected. If your service is disconnected, it shall be reconnected only upon payment of all past due charges and reconnection fees.
 By selecting this box, you certify that all information entered into this form is accurate and complete.