2. 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.

4. Account Number*
6. Service Address*
8. First Name*
9. Last Name*
11. City*
12. State*
13. Zip*
15. Contact Phone*
16. Contact Email
18. Comments or questions
20. 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.

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field