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Utility Payment Extension Form

  1. City Logo

  2. Utility Payment Extension Form

  3. PAST DUE AMOUNTS MUST BE PAID BEFORE THE 15TH OF THE MONTH. I AGREE TO PAY MY BILL AS FOLLOWS:

  4. I understand that by submitting this form, I have relinquished my rights for any further delinquent notification and that future notices will not relieve me of these arrangements. I understand that FAILURE TO PAY by the specified date on this form WILL CAUSE THE CITY TO DISCONTINUE MY WATER SERVICE at the specified address on this form. I understand that additional fees will be charged for any water service reconnection. This extension will not eliminate penalties being imposed. A City representative will contact you for additional confirmation.

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