Payment Arrangement Request

Date of Request

Account Type

Residential

Non-Residential

Business Name

Prefix

First Name

Middle Initial

Last Name

Suffix

Cell Phone

Home Phone

Business Phone

Street Address

City

State / Province

Postal / Zip Code

Country / Region

If mailing address is outside the USA.

Same as the Mailing Address?

If you check this box, you will not need to fill out the service address information below.

Street Address

City

State

Zip Code

BWS Account Number

Best Day(s) and Time(s) to Contact

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Reason Unable to Pay

COVID-19

Not COVID-19 Related

Reason Type

Business Closed

Furlough

Job Loss

Layoff

Other

Reason Type Explain

If you selected Other, please explain below:

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Event Effective Date

Payment Plan Requested

A Payment Arrangement is a plan to pay the current bill charge plus the Previous Balance in Monthly Installments.

I currently have a Payment Arrangement and request to establish a new arrangement.

I am requesting to establish a Payment Arrangement.

Monthly Payment Total

If you are requesting to establish a Payment Arrangement for the first time, please complete the following statement:

I am requesting that the Board of Water Supply (BWS) accept a Total Monthly Payment of

Monthly Payment Beginning

Beginning

Monthly Payment Length

For this many months:

Notification

I will be notified by the BWS regarding this matter and will respond promptly.

Contact Information

I will ensure BWS has my current contact information at all times. I will email changes to customerservice@hbws.org.

Billing

I understand that I will continue to be billed for all water and sewage usage, and that the BWS encourages me to make regular payments of any amount I can afford at this time to keep my bill as low as possible.

Requester Name

To complete your request, enter your FULL LEGAL NAME.

Date

Security Code

View or pay your bill online

Your BWS Water Quality Report

Water Sensible Rebates

Water Waste Hotline

BWS Public Meetings

Customer Service

Make a Payment Arrangement

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If you selected Other, please explain below:

Character limit: 500. To expand this field, click and drag the bottom right corner of the field.