1

Contact and Account Information:

 *

Contact and Account Information:

First Name:	Last Name:
Account Number:	Service Address:
Phone:	Email:

2

Are you the owner or tenant?

Are you the owner or tenant?

Owner

Tenant:

3

Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)

	Date You Will Make Payment	Method: In person, mail, online, by phone	Amount You Will Pay
Payment 1	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)
Payment 2	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)
Payment 3	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)
Payment 4	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)	Payment Plan Terms Requested: (Include method of payment in person, by mail, online, or by phone)

4

Longer Term Payment Plan Requested: Check Box for any payment plan requested that is more than 60 days.

 *

Longer Term Payment Plan Requested: Check Box for any payment plan requested that is more than 60 days.

Yes, I need more than 60 days for payments.

No, I can make the payments within 60 days.

5

Longer Term Payment Plan Details: (If you are requesting a longer term payment plan, please add the payment terms requested.)

Longer Term Payment Plan Details: (If you are requesting a longer term payment plan, please add the payment terms requested.)

6

Additional Information/Comment:

Additional Information/Comment:

7

Submission of this request does not guarantee the acceptance of the terms of the payment plan requested. If approved you will receive a confirmation email outlining the terms of the payment plan made along with any other important details.

Contact our office at (530) 642-4000 or via email to Billing@EID.org to inquire about a leak adjustment if bill is high due to a leak.  

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

Page 1 / 1