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Payment Arrangement Form

  1. Arrangement Request
    Payment Arrangements are treated as payment extensions and can only be granted once per quarter, with a max of 4 per year. An arrangement will defer the amount owed by seven (7) days beyond the scheduled Final Notice cut-off date. There is a $10 administrative fee for each Arrangement. Requests must be received and accepted in advance, prior to the scheduled cut-off date. Arrangements are not considered finalized without an email confirmation of acceptance from the Utility Billing Department. Accounts with less than 3 months of credit history are not eligible for an extension. If you have any questions about the status of a request, please call 972-564-7304 M-F 8AM-5PM.
  2. Utility Account Number
  3. Please provide the ID/DL number on your account to verify your identity.
  4. Request Date
  5. Utility Service Address
  6. Please enter the amount, including arrangement fee, you are requesting to defer.
  7. Payments must be received no more than 7 DAYS after cutoff date, includes weekends.
  8. A confirmation will be emailed to this address to confirm if the payment extension is accepted. Please call if you do not receive an email confirmation.
  9. I agree to the Arrangement terms identified here. I understand that standard late fees will be charged per ordinance on any outstanding balance and I acknowledge that if the payment terms are not met as stated above, my account will be charged an additional $50 Administration Fee and my service will be disconnected. I understand service will NOT be reinstated until payment is received in full. I acknowledge that arrangement extensions can ONLY be requested once per quarter and will not be allowed if the account has failed an arrangement within the prior 12 months or has already had an arrangement extension within the current quarter (3 months). The City of Forney has the right to refuse arrangement extensions for any reason.
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  11. This field is not part of the form submission.