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:
Contact Number: Email:
City: State: Zip Code:
Requested Payment Date(s):
Requested Payment Amount(s):
Payment Method / Location:
Please mail completed form to firstname.lastname@example.org.
Please download the form and then hit
"Submit Form" to email us. Mahalo.