Payment Plan Application

Payment Plan Application
Eligibility: Customers who contact Santa Margarita Water and advise the District of a financial hardship will be offered up to a 6-month payment plan. Please complete the form below with your desired arrangement. Management will review your proposal and will respond within 2 business days. If you have questions or require additional time, please call Customer Relations at (949) 459-6420.
Name*

First NameLast Name
Social Security #*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Customer Number*
Account Number*
Outstanding Balance*
Payment Plan Duration*

1 Month3 Months6 Months
Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payment Frequency*

MonthlyBi-Weekly
Monthly Payment
I, {name} the undersigned customer of record, do understand and accept the terms and conditions of this payment plan with the Santa Margarita Water District. I agree to meet the following obligations:

1. To make the payments listed above plus the current charges no later than 5:00 p.m. on the statement’s due date.
2. Provide a copy of current valid driver’s license to SMWD.

The Santa Margarita Water District agrees to suspend any and all credit action, including delinquent charges, for as long as this contract is valid. I acknowledge that I have been given a copy of this payment contract.
*

I agree
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