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Agreement.2

  1. Water District
  2. Coachella Valley Water District
    Request to Enter Into a Payment Plan





  3. Please read and complete the information below to request a payment plan.

    I understand and acknowledge that:*
    (Check all that apply)
  4. Primary Telephone Number Type*
  5. Secondary Telephone Number Type
  6. Timeframe requested to pay balance:*
  7. Terms & Conditions
    I understand that my first payment will be due 10 days from this agreement date. Future payments will be due on the due date of each monthly bill.

    I agree to keep my account current during the time period requested above. If I fail to make payments as agreed upon, the payment plan will become void, delinquency fees and late charges will be added to my account, and the total outstanding balance will become due IMMEDIATELY.
  8. COACHELLA VALLEY WATER DISTRICT
    Post Office Box 1058
    Coachella, California 92236
    (760) 391-9600
    (760) 398-3190 - fax
    CustomerService@cvwd.org

    rev 8/2020
  9. Leave This Blank:

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