Toledo, WA · Lewis County
Payment Arrangement Request Form
Toledo water and sewer account holders use this form to request a payment arrangement and record the proposed payment schedule.
What this form is
This form lets a City of Toledo water or sewer account holder request a payment arrangement and set out the number of payments, payment amounts, and final payment due date. It records acknowledgements about bringing the account into good standing within 30 days and possible service disconnection if payment is not made by the agreed date. The account holder and Utilities Clerk sign and date the form.
Who needs it
A City of Toledo water or sewer account holder seeking a payment arrangement should complete this form.
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; the account holder and Utilities Clerk sign and date it, and no notarized or sworn attachment is listed.
How to submit this form
- 1
Download The Form
Download the City of Toledo Payment Arrangement Request Form.
- 2
Complete The Form
Enter the date, account number, account holder name, proposed payment schedule, and final payment due date; initial each acknowledgement.
- 3
Sign And Date
The account holder signs and dates the request. The form also includes a signature and date line for the Utilities Clerk.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the Payment Arrangement Request Form do?
- It lets a City of Toledo water or sewer account holder request a payment arrangement and record the number of payments, payment amounts, and final payment due date.
- What account information and acknowledgements does the form ask for?
- It asks for the date, account number, account holder name, proposed payment details, and initials acknowledging the terms about bringing the account current and possible disconnection.
- Do I need a notary for the Payment Arrangement Request Form?
- No. The account holder and Utilities Clerk sign and date the form; it lists no notarized or sworn attachment.
- How do I submit the Payment Arrangement Request Form?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Payment Arrangement Request Form doesn’t need a notary — but if you have another Toledo form that does, a commissioned online notary can help.