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Utility Bill Payment Extension Request Form

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UTILITY PAYMENT EXTENSION REQUEST
Use this form to submit a request for an extension on your utility bill. Extension must be submitted by 5:30 pm on the 20th of each month.
Account Number*
Service Address*
First Name*
Last Name*
City*
State*
Zip*
Contact Phone*
Contact Email
Comments or questions
NOTICE
By selecting the submit button, I am agreeing to pay my current bill plus the 10% late fee by 5:30 pm on the last day of the current month.

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Email address

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