Extension Request

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Name *

Street Address *

Email *

Phone Number *

Utility Account Number *

I understand that by submitting this form to the City of Denison I am requesting an extension on the past due balance for this utility account. *

Yes

I understand that if granted, my extension will be due the day before the current bill is due, and that the current bill will either need to be paid or a new extension requested within two weeks of the due date. *

Yes

I understand that if payment is not made by the extension due date I can be subject to cut off. *

Yes

I understand by submitting this form that the City of Denison has the right to deny my request. *

Yes

Disclaimer: Extensions will be due the day before the following month's bill is due. Extensions will not be granted to accounts that have had one failed extension within a 12 month period. Extensions will not be granted once the service has been terminated due to non-payment. Once the extension is reviewed, you will receive an email letting you know if the extension is approved or denied. Approval or denial is at the discretion of the utility billing department.

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Extension Request

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