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2. Program Information

   The Average Payment Plan divides into twelve equal monthly payments, the total cost of your water, sewer, and ambulance charges for the year. Your account will be reviewed every six months to determine if your usage has changed. If so, an appropriate adjustment will be made to your Average Payment Plan amount, reflecting either decreased or increased usage. Any price changes will be automatically figured into the average payment amount. You pay for only the water you use but at a fixed amount each month. To sign up for the Average Payment Plan, your account must be current with $0 owing. You may cancel this program at any time; however, the account must be brought current at that time.

   Eligibility requirements for the budget pay plan shall include:

   1. The account has been in full-service status for at least 12 consecutive months and has not incurred a late-pay penalty.
   2. That the account for the address being serviced is current.
   3. The monthly budget billing amount is paid in full each month before incurring a late pay penalty.
   4. The service address must be a single-family dwelling unit.

   If you meet these eligibility requirements and the average payment plan will meet your budgeting needs, then please fill out the application below, or download the application here. We will be happy to add your name to the list of Average Payment Plan customers.

4. Yes, sign me up for the Average Payment Plan!

   1. I have read this information and I meet the eligibility requirements.
   2. I understand that if the account becomes delinquent, I will be removed from the Average Payment Plan program.
6. Full Legal First Name: *
7. Middle Name or Initial:
8. Full Legal Last Name:*
10. Account Number
12. Service Address:*
14. Mailing Address (if different than Service Address):
16. City*
17. State*
18. Zip*
20. Primary Phone Number: *
21. Secondary Phone Number:
23. Email Address:
25. Signature*

    By typing your name here, you agree to submit your information and the acknowledgments made.

27. PLEASE NOTE

    Your e-mail and any e-mail responses from the City are considered a public record and will be subject to disclosure under Washington’s Public Records Disclosure Act.

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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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