Utility Billing Appeal Request Form

If payment in full is not received by the Town on or before the third Tuesday of the month in which the charges were billed, they shall be deemed delinquent. To avoid disconnection of services, the following appeals process has been initiated to allow citizens an opportunity to request alternatives regarding suspension or termination of the account on the fourth Tuesday of the month.

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Your Name

Your Email

Phone Number

Account Number

Service Address

Address 2

City/Town

ZIP/Postal Code

Account Details

Total Amount Due

Proposed Payment Date

Reason for Delinquency

Owner Information

Owner Name

Owner Phone

Owner Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Owner or Tenant Signature

Utility Billing Appeal Request Form

Town of Platteville

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