Utility Extension Form

To complete your extension request, fill out the form below and click Submit, or stop in to City Hall to speak directly with staff.

Payments must be made by 9:00 AM the morning of the extension date to avoid shutoff fees.

Extension requests set on a Friday, holiday, or weekend will NOT be approved.

Name

Address

Contact Number

Date Extended to:

You cannot extend past the due date of the next bill. You cannot extend to a Friday. All Extension deadlines are 9:00 AM.

Payment Plan

If you need to break up your amount due into more than one payment, please describe exact dates and amounts.

Amount Due

If you do not know your amount due, call City Hall and they can look it up for you, 503-749-2030.

Account Number

If you do not know your account number, this can be left blank. City Hall staff can look up your account based on your address.

Signature

By typing my name I agree to the following statement: IF NOT PAID AS STATED ABOVE, WATER WILL BE SHUT OFF. THIS FORM SERVES AS YOUR NEW MINIMUM 72 HOUR SHUTOFF NOTICE. AN ADDITIONAL $30.00 RECONNECT FEE WILL BE CHARGED TO RESUME SERVICE, IF SHUT OFF FOR NON-PAYMENT. Deadlines are always 9:00 AM. Do not set your extension for a Friday or it will not be approved.

*If a payment is not provided by the extension date, extension privilege will be suspended for 90 days from the missed extension date.

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