Midlothian, TX · Ellis County
Hardship Utility Payment Form
Midlothian utility customers use this form to request a hardship payment arrangement and provide their account, contact, and payment information.
What this form is
This form lets a utility customer request hardship help with a payment and explain the reason for the request. The form states that payment arrangement requests must be received by noon the day before cutoff, or by noon on the last business day before a holiday or weekend closure. It asks for the amount due, account and contact details, service address, reason, signature, and date.
Who needs it
A Midlothian utility customer seeking a hardship payment arrangement should complete the form with account details and the reason for the request.
How to submit it
Email it to [email protected] and call (972) 775-7130 to verify receipt. The form also lists the City of Midlothian address as 215 N 8th St., Midlothian, TX 76065.
About notarization
This form has no notary block; the customer signs and dates it, and no notarized attachment or sworn step is stated.
How to submit this form
- 1
Download The Form
Download the Hardship Utility Payment Form PDF.
- 2
Complete The Form
Enter your payment amount, account and contact details, service address, reason for the request, signature, and date.
- 3
Check For Attachments
The form does not list any required attachments.
- 4
Submit To The City
Email the form to [email protected] and call (972) 775-7130 to verify receipt.
Frequently asked questions
- Do I need a notary for the Hardship Utility Payment Form?
- No. The form has no notary block; the customer signs and dates it, and it does not state that a notarized attachment or sworn step is needed.
- How do I submit the Hardship Utility Payment Form?
- The form lists [email protected] for email and says to call (972) 775-7130 to verify receipt if emailing. It also lists the City address at 215 N 8th St., Midlothian, TX 76065.
- What information does the hardship utility form ask for?
- It asks for the total due, account number, name, service address, phone, cell, email, reason for the request, signature, and date.
- When must a payment arrangement request be received?
- The form says requests must be received by noon the day before cutoff, or by noon on the last business day before the city is closed for a holiday or weekend.
Need something notarized?
This Hardship Utility Payment Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.