Utilities Short-Term Payment Plan Request

The City of San Clemente is committed to helping our users catch-up on unpaid utility bills.  The City offers different payment plan options to meet your financial needs.  Please review the options below and select the option that is best for your situation.  If you require a payment plan for more than 12 months, please contact our customer service call center at the number below.  Your Payment Plan Request will be reviewed and added to your account within two business days. 

***If you have received a shut-off notice, please contact customer service at the phone number below.  Submission of this form does not cancel any previously scheduled shut-off orders.***

Customer Service Call Center
Phone: 949-361-8315 menu option 4
Business Hours: 8:00 a.m. - 5:00 p.m. Monday - Thursday and Alternating Fridays.

1

Requestor Contact Information  (Required)

 *

Requestor Contact Information (Required)

Name

Phone Number

Email Address

Relation to Account Holder

2

Account Information  (Required)

 *

Account Information (Required)

Account Number (8-digit: XXXXXX-XX)

Service Location Address

Account Holder Name

Past Due Amount (Amount to be Deferred/Amortized)

Payment Plan Terms

Payment Plan Requests will be automatically approved for accounts that have not defaulted on any previous payment plan in the prior 24 months.  If you are not eligible based on this criteria, your plan will be reviewed by Staff prior to approval and a representative will contact you to discuss your individual case. 

During the repayment period, the current charges as shown on your monthly statements must be paid on their respective due dates.  If you are on an amortization installment plan, your monthly payment due is the sum of your installment amount and the current charges on your most recent statement.  Missing a payment of current charges and/or the payment plan amount will cause the payment plan to be considered in default and the account immediately becomes subject to disconnection of service.  If you are experiencing difficulty with your scheduled payments, please contact a customer service representative to ensure continuous water service. 

3

Select a payment plan option:  (Required)
Your choice overrides any conflicting selections on the following questions. 

 *

Select a payment plan option: (Required) Your choice overrides any conflicting selections on the following questions.

Temporary Deferral of Payment: Pay off your full past-due balance in a single future installment scheduled for a specific date.

Amortization: Pay off your full past-due balance in equal monthly installments scheduled on each subsequent due date in the repayment period.

Alternative Payment Schedule: Pay off your full past-due balance in custom installment amounts scheduled on each subsequent due date in the repayment period.

4

If you chose Temporary Deferral of Payment, please enter the proposed repayment date below:

If you chose Temporary Deferral of Payment, please enter the proposed repayment date below:

Proposed Repayment Date

Comments (optional)

5

If you chose Amortization, please enter the proposed number of monthly installments below:

 *

If you chose Amortization, please enter the proposed number of monthly installments below:

Number of Monthly Installments

Comments (optional)

6

If you chose Alternative Payment Schedule, please enter the proposed monthly installment amounts below: 
Note: If your requested amounts do not equal the unpaid balance, your plan will be approved with modifications.

Most commonly used for unexpected high water bills (water leaks) where users choose a larger installment for their first payment and smaller installments until the balance is paid off.  If the water leak or cause of high usage continues into future cycles, the payment plan may be amended by contacting our customer service call center at the number above. 

If you chose Alternative Payment Schedule, please enter the proposed monthly installment amounts below: Note: If your requested amounts do not equal the unpaid balance, your plan will be approved with modifications. Most commonly used for unexpected high water bills (water leaks) where users choose a larger installment for their first payment and smaller installments until the balance is paid off. If the water leak or cause of high usage continues into future cycles, the payment plan may be amended by contacting our customer service call center at the number above.

First Installment Amount

Second Installment Amount

Third Installment Amount

Fourth Installment Amount

Comments (optional)

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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