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Payment Extension Request Form


  1. 1. Step One
  2. 2. Step Two
  3. 3. Acknowledgement
  • Step One

    1. Payment Extension Request Form
      Please fill out the following form to request a payment extension for your monthly utility bill.
    2. Please note that submitting this form to the City of Melissa Utility Billing Department does not guarantee approval for a payment extension. After review, a staff member will respond via email.
    3. Acknowledgement*