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Utility Billing 15 Day Extension Application

  1. CITY OF BLYTHE
    Utility Department
    235 N Broadway - Blythe, CA 92225
    (760) 922-6161 ext. 1233 or 1234

    PLEASE COMPLETE ALL INFORMATION:

  2. Amount Due On:

    AUGUST 25, 2022
  3. A signature is required to process your request.

    By entering your valid email address in the box above you are signing this form and confirming that you understand the following:

    • Failure to pay the total amount by 10:00am the day after the due date will result in disconnection of service.
    • A $37.00 reconnect fee will be charged, whether service has actually been disconnected.
    • Once disconnected, all amounts due will need to be collected to reestablish service.
    • Balances owed that are not received and credited to the account, by the 19th day of the month, will be assessed a fee of 10%.
    • This is your final notice for the past due amount.
    • Extension forms can also be found in our office. Extensions are not given over the phone.
  4. NO FURTHER EXTENSIONS WILL BE GIVEN.
  5. Entered By: ____________________ Date Entered: __________
  6. Leave This Blank:

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