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2. Notes Regarding Payment Arrangements
   • Utility customers have a maximum of 20 days from the scheduled shut-off date to pay their account balance in full per the terms agreed upon in the payment arrangement.
   • In order for renters to make payment arrangements, their landlord must approve the payment arrangement request. The City of Stanwood may accept a verbal agreement from the landlord however the City must receive a signed agreement from the landlord within seven days of the verbal agreement (faxed or emailed agreements may be accepted).
   • If payment is not received as arranged, water service will be shut off and a turn-on fee will be applied.
6. Date
   Date
7. Account Number
9. Service Address
11. First Name
12. Last Name
14. Service Location - For Office Use Only
16. Account Balance
17. Date to Be Paid in Full
    Date to Be Paid in Full
21. Electronic Signature Agreement

    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.

    1. I agree.
23. Electronic Signature
24. Date
    Date
26. For Office Use:

    1. Received Landlord Approval
    2. Verbal
    3. Written
28. Date
    Date
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field