Rohnert Park, CA · Sonoma County
Utility Billing Payment Arrangement Application
Rohnert Park utility account holders use this application to request a payment arrangement and provide information about qualifying household assistance or income.
What this form is
This application lets a Rohnert Park utility account holder propose a payment arrangement for a bill. It includes forms to certify primary care needs, document qualifying financial assistance, or declare household income, along with an agreement listing proposed payment amounts and due dates. Complete the sections that apply to your situation and provide the requested proof of assistance when applicable.
Who needs it
A Rohnert Park utility account holder seeking a payment arrangement should complete the applicable account-holder sections and provide any required proof of assistance.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; it includes declarations under penalty of perjury and requests proof of assistance when applicable, but no notarized attachment.
How to submit this form
- 1
Download The Application
Download the Utility Billing Payment Arrangement Application PDF.
- 2
Complete Applicable Sections
Enter account and bill details, then complete the sections that apply to your situation.
- 3
Gather Supporting Proof
Provide the requested proof of assistance if applicable; complete the household income declaration if that form applies.
- 4
Sign And Submit
Sign the applicable declarations and payment arrangement agreement, then submit the application to the city department named on the form.
Frequently asked questions
- Do I need a notary for the Utility Billing Payment Arrangement Application?
- No. The document has no notary block. It includes declarations under penalty of perjury, and may request proof of qualifying assistance, but no notarized attachment.
- What information does the application ask for?
- It asks for utility account and bill details, and, depending on the applicable forms, primary care provider information, proof of assistance, household income, and proposed payment amounts and due dates.
- How do I submit the Utility Billing Payment Arrangement Application?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Utility Billing Payment Arrangement Application doesn’t need a notary — but if you have another Rohnert Park form that does, a commissioned online notary can help.