Utility Payment Arrangement Request Form

Managing utility bills during financial hardship can be overwhelming, but municipal utility providers understand that circumstances change. This utility payment arrangement request form helps customers with past due water, sewage, or other municipal utility accounts request flexible payment plans while documenting their financial situation.

Designed for municipal utility departments and customers facing temporary financial difficulties, this template streamlines the payment arrangement process by collecting account information, financial hardship documentation, and proposed payment schedules in one secure, professional form. Whether you're a utility billing department, city treasurer's office, or municipal services provider, this form helps you assess hardship requests fairly and efficiently.

Paperform makes it easy to customize this template with conditional logic that adapts to different hardship circumstances, secure file uploads for required documentation, and calculation fields that help customers propose realistic payment schedules. Connect submissions directly to your billing system, CRM, or customer service platform to ensure prompt review and response.

For utility departments managing high volumes of arrangement requests, Stepper (stepper.io) can automate your approval workflow—routing applications to the right reviewers, triggering status update emails, creating payment plan records in your billing system, and tracking follow-up requirements. This ensures no request falls through the cracks while giving your team the tools to help customers stay connected during challenging times.

This form template supports government utility providers committed to fair, accessible customer service while maintaining operational efficiency and payment compliance.