Bevil Oaks, TX · Jefferson County
Payment Extension Request
Customers use this form to request a later date to pay a bill and explain the reason for the extension.
What this form is
Use this form to request an extension on a bill payment and provide a requested payment date and reason. It asks for the customer’s name, account number, address, and signature. The form states that water service will be disconnected if payment is not made by the requested date, and includes office-use fields for the decision and billing details.
Who needs it
A customer seeking more time to pay a bill can use this form to request an extension and provide a requested payment date.
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 request is signed and dated without a notary; it includes an office personnel signature and date, but no notarized or sworn attachment.
How to submit this form
- 1
Download The Form
Download the Payment Extension Request form.
- 2
Complete The Request
Enter your customer and account details, explain the reason, and provide the requested payment date.
- 3
Sign And Date
Sign and date the customer section; the form has a separate section for office personnel.
- 4
Submit To The City
Submit the completed form to the city department named on it; check the city website for current contact details.
Frequently asked questions
- What information does the Payment Extension Request ask for?
- It asks for the customer’s name, account number, address, reason for the extension, requested payment date, and customer signature and date.
- Do I need a notary for a Payment Extension Request?
- No. The request is signed and dated without a notary. It includes an office personnel signature and date, but no notarized or sworn attachment.
- How do I submit a Payment Extension Request?
- Submit it to the city department named on the form; check the city website for current contact details.