City of Perry, Georgia 31069

Including Perry Incorporated Kathleen

Utility Bill Payment Extension Request Form

***ONLY THE ACCOUNT HOLDER CAN REQUEST AN EXTENSION***

Extension requests must be submitted by 5:00 p.m. one business day prior to the disconnect date. Extensions provide an extra week to pay. Only two extensions will be granted per calendar year, and the customer must have a 12-month good-standing history to be eligible. Extensions will not be granted back-to-back months. If a customer fails on their extension, no more are granted.

Account Number

Phone Number

Check the below:

I understand that if I fail to pay the full balance by the extension date I am subject to be cutoff without further notification and I will not receive another extension.

I understand that once disconnected the balance must be paid in full in addition to the $60.00 (during normal business hours) reconnection fee. Utilities will not be restored until such payments have been made.

I understand that I am allowed 2 extensions per 12 month period. Bill payment extension request will not be approved consecutively.

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First Name

Last Name

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Draw Type

Disclaimer: Submitting this form request does not guarantee an extension. One of our customer service representatives will contact you with further instructions.

Picture ID of the account holder

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disregard this