Form Center

2. 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.
6. Customer Information
8. Date:*
   Date:
   insert today's date
9. 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.
11. Account Holders name *
    Provide the name which is listed on the account.
12. E-mail Address*
    The e-mail provided will be used to set-up E-billing notification
16. 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.
18. Customer Signature:*
19. Date:*
    Date:
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

* indicates a required field