FORM 998-C
Agreement for Payment
Arrangement
CITY OF MANTECA UTILITY BILLING
THIS SECTION TO BE COMPLETED BY CITY STAFF
The following payment arrangement is proposed between City of Manteca and the account holder named below. The account holder must sign this agreement for the payment arrangement to take effect. _____________________________________ ___________________________________________ Account Number Service Address
_____________________________________ ___________________________________________ Account Holder Name Date & Amount of Bill seeking Payment Arrangement Payment Arrangement Schedule
# Minimum Payment Amount Due By (Date) Remaining Balance After Payment
1. 2.
3. 4.
5. 6.
• Per section 116910.(b)(2) of the California Health & Safety Code, City staff may choose the payment option the account holder undertakes and may set the parameters of that payment option.
• Payment arrangements or alternative payment schedules may only be made between City staff and the account holder.
• An account holder may only have one payment arrangement or alternative payment schedule per account at a time.
• A payment arrangement or alternative payment schedule shall be considered null and void if any part of it is not kept for 60 calendar days or more, or if water charges contained in current bills are not paid for 60 days or more.
• Currently utility bill amounts must be paid in full by the billing date. Payment Arrangement amounts may be paid ahead of schedule or in excess of the scheduled amount. All payments will apply against the oldest charges first. Failure to pay current bill amounts by the bill’s due date will result in shufoff of service as soon as those amounts are 60 days overdue.
I, the account holder, agree to the payment arrangement described above. _____________________________________ _________________________________________ Account Holder Signature Date
THIS SECTION TO BE COMPLETED BY CITY STAFF
Date & Time Received Received By Completed
ATTACHMENT 6