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2. Instructions
   This application is for customers on a fixed income, which means that they receive one (1) check per month at a scheduled time. You do not qualify if you are employed and receive regular paychecks. You will be subject to late fees, penalty fees, or disconnection of service for nonpayment.
4. Date*
   Date
   Please insert today's date
5. Phone*
6. Account Number *
   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.
8. Account Holder's name
9. Service Address:
   Address, City, State, Zip
13. Permanent Due Date Information
15. Social Security /Disability Check is received on:*
16. Change Water/Wastewater Utility Bill Due Date to:*
20. Acknowledgement and Signature*

    By signing this application, I agree to the following:

     

    I have read and agree to all Terms and Conditions outlined in the Water and Wastewater Rules and Rates codified as Chapter 51 of the Rio Rancho Code of Ordinance. A copy of these Terms and Conditions is available at the City Clerk’s Office or online at https://www.codepublishing.com/NM/RioRancho/

     

    In the event of non-payment, I agree to pay all past due amounts, applicable late fees, and all costs and expenses of collecting

    
    

    such delinquent amounts, including reasonable attorney’s fees and collection agency fees of up to 20% of the total owed.

21. Date*
    Date

23. Revised: May 2024 | Phone: (505) 891-5020 | Fax: (505) 891-5204 | Email: UtilityCustomerService@rrnm.gov

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25. Submit Submit and Print

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