2. 

4. Customers who cannot pay their balance due to a hardship may apply for a deferred payment. Request must be made before the shut-off date and customer maybe required to provide written documentation as proof of hardship. A down payment will be required and the remaining balance will be divided into installments. Deferred payment amounts shall be in addition to the regular service bill amount and must be paid to keep water on. If the customer is a renter, permission must be granted by the landlord or property manager prior to initiating the agreement.

   
   

   
   

6. Account Holder Name*

   All deferred payment plan requests and agreements MUST be completed and signed by the account holder.

8. Account Number
10. Service Address*
12. Phone Number*
14. Email Address*

    Please include your email address so we can send you a deferred payment plan agreement.

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16. 1. Receive an email copy of this form.
17. Email address

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