CUSTOMER SERVICE FORMS

Make a Payment Arrangement


* Fields marked with an asterisk are required.


Payment Arrangement Request Details

Enter today's date.

Account Type

Indicate if this is a residential or non-residential account.

Contact Information

Enter the business name.

Enter a prefix (optional).

Enter a first name.

Enter a middle initial (optional).

Enter a last name.

Enter a suffix (optional).

Enter a cell phone number.

Enter a home phone number.

Enter a business phone number.

Mailing Address

Enter a street address.

Enter a city.

Enter a state.

Enter a zip code.

If mailing address is outside the USA.

Service Address

Indicate if the service address is the same as the mailing address.

Enter your street address.

Enter your city.

Enter your state.

Enter a zip code.

Payment Arrangement Details

Enter the account number.

Character limit: 500. To expand this field, click and drag the bottom right corner of the field.

Reason Unable to Pay

Select a reason unable to pay.

Reason Type

Select the type of reason unable to pay.

If you selected Other, please explain below. Character limit: 500. To expand this field, click and drag the bottom right corner of the field.

Enter the event effective date.

Payment Plan Requested

A Payment Arrangement is a plan to pay the current bill charge plus the Previous Balance in Monthly Installments.

If you are requesting to establish a Payment Arrangement for the first time, please complete the following statement: I am requesting that the Board of Water Supply (BWS) accept a Total Monthly Payment of

Indicate when you would like the monthly payment plan to begin.

Indicate how many months you would like to have a payment plan in place.

Acknowledgements

Check the box after reviewing the acknowledgement (required).

Check the box after reviewing the acknowledgement (required).

Check the box after reviewing the acknowledgement (required).

To complete your request, enter your FULL LEGAL NAME.

Enter today's date.


Posted: 05/14/2020

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