Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Application for Deferred Payment Plan

  1. Deferred payment plan eligibility. The Administrator may enter into not more than one deferred payment plan per account per calendar year. The customer must submit an application demonstrating an extreme hardship to be eligible for a deferred payment plan. It is the intent of the City Council that extreme hardship will be recognized only in the most unusual circumstances. The Administrator has sole discretion to approve or deny an application, based on the following factors: (1) The extent to which the circumstance leading to the delinquency was caused by factors beyond the control of the customer; (2) The financial resources available to the customer; and (3) The likelihood that the customer will be able to perform under the deferred payment plan in a timely manner.
  2. Deferred payment plans. If the Administrator approves a customer's application for a deferred payment plan, the customer will be required to execute a written agreement that: (1) Requires the customer to pay for all future services before the account becomes delinquent; (2) Provides up to, but no more than, six months to pay all delinquent amounts in equal or as nearly equal as practicable monthly installments; (3) Includes payment of a deferred payment fee at the time the plan is approved; (4) Provides that in the event of any default of the deferred payment plan, utility services and, for delinquent wastewater bills, water service provided by Martindale Water Supply Corporation, will be terminated/disconnected without further notice.
  3. Section 1. Household Size / Description
  4. Section 2. Monthly Household Income
  5. Section 3. Monthly Household Expenses
  6. Section 4: Nature of Hardship
  7. (for example, completed unemployment application)
  8. Section 5. Proposed Repayment Schedule
  9. (due at time of agreement signature)
  10. (Divide the remaining balance after down payment by the number of months)
  11. Attestation
    By submitting this form, I certify that I have completed this application for a deferred payment plan fully and truthfully to the best of my knowledge. I understand that the City of Martindale may attempt to verify some or all of my statements to determine whether to establish a deferred payment plan agreement in accordance with City of Martindale Code of Ordinances Chapter 50, Sewer/Wastewater Provisions, and Chapter 51, Solid Waste and Recycling as applicable
  12. Leave This Blank:

  13. This field is not part of the form submission.