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Agreement for Utility Bill Payment Extension

  1. CITY OF BRISTOL, TENNESSEE
    FINANCE DEPARTMENT
    AGREEMENT FOR UTILITY BILL PAYMENT EXTENSION

  2. CUSTOMER INFORMATION

  3. UTILITY BILL PAYMENT INFORMATION AND TERMS

  4. I (We) hereby agree to pay the amount in arrears for this utility bill account to the City of Bristol, Tennessee in accordance with the following payment plan and terms:

  5. In addition to this payment plan option, the current monthly charge for services must also be paid each month in a timely manner.

  6. Failure to make payments in accordance with the terms indicated above will result in:
     Payment of the total amount due in full upon demand.
     Disconnection of existing utility services on the date that the agreement terms are broken.
     A service charge of $30.00 - $40.00 to restore utility services will be charged to your account.
     Additional payment agreements will not be allowed for a twelve month period.

    Two agreements in a twelve month period are the maximum allowed unless extenuating circumstances. Approval for an additional agreement must be granted by the Director of Finance, Accounting Manager, or Accounting Supervisor.

  7. ACCEPTANCE OF AGREEMENT AND TERMS

  8. I (We) have read and accept the terms of this agreement as stated above.

  9. Please call a customer service representative at 423-989-5500 or email customerservice@bristoltn.org with any questions regarding your agreement for a utility bill payment extension.

  10. FOR INTERNAL USE ONLY.

  11. Leave This Blank:

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