have been financially impacted by the COVID-19 virus and request a flexible payment plan.
I request to pay my outstanding Covid-19 balance over the next
in equal installments (maximum 6 months for balances less than $500, and 12 months for all others). I understand that I will continue to be billed the regular, bi-monthly charges separate from the COVID-19 Emergency Flexible Payment Plan. As the account holder, I understand that I am responsible for the amount due on my account.
In consideration of the above and if the application is ultimately approved, the City of Stanwood will not pursue, and will essentially put on hold, any collection action against me. I understand that if I default or breach this agreement, City of Stanwood may pursue its right to collection action. I understand that I am in default if a payment is returned as insufficient funds (NSF) or is 45 days late. Customers must apply for a payment plan by December 31, 2021, to avoid late fees and disconnection of services.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Approved By: __________________________________________
_____ Outstanding balance verified
Rejected Reason: ______________________________________
_____ Payment amount verified
First payment Due Date: __________________________________
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