REQUEST FOR MORE TIME TO PAY

Note:  A payment arrangement will not be granted if today's date is later than the "Last Date To Pay" listed on the utility bill disconnect notice. 

*Indicates a required field. 

Customer Information

*Name:  
*Address:  
*Home Phone Number:  
*Cell Phone Number:  
*Email Address:  
*Last 4-digits of SSN, SSI, DL or Passport:  
Account Number :
   
* DATE YOU ARE REQUESTING TO PAY YOUR BILL:    
*AMOUNT YOU WILL PAY:    
 
Completing this form does not guarantee that your arrangement will be granted. 
You will receive an email response to communicate the status of your request.
  Online requests can take 2-3 business days for processing.  For immediate consideration, please call 644-2221 and select option 3 for More Time To Pay.  
City of Mesa business hours are 7:00AM - 6:00PM Monday through Thursday.