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E-Billing Request Form

  1. Instructions
    You will still be subject to late fees, penalty fees, or disconnection of service for non-payment. It is your responsibility to update the Utility Service Division with your e-mail address if it changes.
  2. Customer Information
  3. insert today's date
  4. You can find the account number on the upper right hand corner of your monthly billing statement. Please provide the full account number including the dash.
  5. Provide the name which is listed on the account.
  6. The e-mail provided will be used to set-up E-billing notification
  7. Acknowledgement and Signature
    I understand that I am “opting-in” or choosing to receive electronic statements, which means that I will no longer receive paper statements or paper delinquent notices. I understand that if I do not pay that my account is subject to: late fees, penalty fees, and that service may be disconnected in accordance to the City of Rio Rancho Ordinances. I also understand that I will need to update the Utility Service Division with any changes to my e-mail address.
  8. Leave This Blank:

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