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Coachella Valley Water District
Request to Enter Into a Payment Plan
Please read and complete the information below to request a payment plan.
I understand and acknowledge that:
(Check all that apply)
The water account is in my name.
I have applied for the Help2Others program administered by United Way of the Desert (residential customers only).
Account Number - First 6 Digits
Account Number - Second 6 Digits
Service Address Line 1
Service Address Line 2
Mailing Address Line 1, if different from Service Address
Mailing Address Line 2, if different from Service Address
State or Province
Zip or Postal Code
Primary Telephone Number
Primary Telephone Number Type
Secondary Telephone Number
Secondary Telephone Number Type
Total amount owed:
Timeframe requested to pay balance:
I understand the requested payment plan amount is IN ADDITION TO my monthly charges
Terms & Conditions
If approved, I hereby agree to pay the installment payments IN ADDITION TO my monthly charges. I understand that my first payment will be due starting with my next 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.
By typing or signing my name, I certify that I understand the terms and conditions outlined above and that to the best of my knowledge the information I provided is true and correct. I understand this request must be approved by CVWD before it becomes valid and I will receive a written determination regarding this request.
COACHELLA VALLEY WATER DISTRICT
Post Office Box 1058
Coachella, California 92236
(760) 398-3190 - fax
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