Fillable Utilities Payment Plan Application (City of Winchester)

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Utilities Payment Plan Application (City of Winchester)

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Country of origin: US
File type: PDF

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Utilities Payment Plan Application
Program Overview
Choose a payment plan for up to 24 months which will be billed every other month (residential customers) or monthly (commercial customers). These charges will appear separately from the
current charges on your bill and both will be due by the due date listed on the bill. The payment plan amount must be paid in full along with your current bill amount to avoid cut-off. No extensions
will be approved.
Once your application has been reviewed, you will receive a letter in the mail with your specific payment plan information.
Customer Information
Account Number
Customer First & Last Name
Address of Acccount Requesting a Payment Plan
Required
Mailing Address (if different from account address)
Phone number
Required
Email Address
Payment Plan Options (Select 1 option) Required
6-month plan
12-month plan
24-month plan
Utilities Payment Plan Application Page 1 of 2
Signature Required
Name
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signature
click to edit
Signature
Required
For
Office Use Only
Total Amount Due
Number of Months for Payment Plan
Monthly Amount Due
Amount Charged Per Billing
Utilities Payment Plan Application Page 2 of 2
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Utilities Payment Plan Application (City of Winchester)

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Completed 22 March 2021

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