Payment Arrangement Request
If you are needing payment arrangements, please provide the following information:
(For security purposes, please do not provide your electric account number.)
Type of account (Select one):
Select Island Region:
Maui County Hawai‘i Island
Name on Account:
Business Name:
Contact Name:
Contact Number: Email:
Service Address:
City: State: Zip Code:
Requested Payment Date(s):
Requested Payment Amount(s):
Payment Method / Location:
Additional Information:
Please mail completed form to
Submit Form
Please download the form and then hit
"Submit Form" to email us. Mahalo.
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