Utility Billing Extension

2. CITY OF BLYTHE
   UTILITY DEPARTMENT
   235 N BROADWAY BLYTHE, CA 92225
   760-922-6161 EXT 1233 or 1234
   15-Day Extension Application
4. PLEASE COMPLETE ALL INFORMATION:
6. First Name*
7. Last Name*
9. SERVICE ADDRESS:*
11. PHONE #*
12. PHONE TYPE:*

    1. CELL PHONE
    2. HOME PHONE
14. ACCOUNT #*
16. PAST DUE AMOUNT:*
17. AMOUNT DUE ON:

    SEPTEMBER 25, 2021

19. Failture to pay the total amount by 10:00 AM the day after the due date will result in disconnection of service.

    
    

    A $37.00 Reconnect Fee will be charged, whether or not service has actually been disconnected.

    
    

    Once disconnected, all amounts due will need to be collected in order to reestablish service.

    
    

    Balances owed that are not received and credited to the account by the 19th day of the month, will be assessed a fee of 10% of the amount owed.

    
    

    THIS IS YOUR FINAL NOTICE ON THE PAST DUE AMOUNT. EXTENSIONS ARE NOT GIVEN OVER THE PHONE.

    
    

    NO FURTHER EXTENSIONS WILL BE GIVEN.

21. Per adopted Resolution No. 2015-001 a 10% late payment fee will be charged on all delinquent accounts

23. A signature is required to process your request. By entering your valid email address in the box below you are signing this form and confirming that the above information is correct.*
24. 
    
    Date:*
    
    
    Date:
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field