Request for Payment Agreement
By checking the boxes below you acknowledge you understand and meet the Payment Extension requirements.
Payment extensions granted require the installment amount to be paid in full by 5:00PM the day before the last business day of month.
The customer understands that failure to make payment in accordance to this agreement, could result in disconnection of water service.
If you do not fulfill the payment agreement, a $35.00 fee will be added to your account and your water will be turned off.
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Utility Account Number
Street Address Line 2
State / Province
Postal / Zip Code
Cell Phone Number
Balance Amount (Amount Day Extension is Requested):
By entering my name I accept the terms of this submission.
You can reach customer service by phone at (919) 557-3925.
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