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Utility Billing Agreement

  1. UTILITY BILLING AGREEMENT

  2. Due to the impact of COVID-19 on the economy and in an effort to assist customers with financial burdens, the City of Daytona Beach suspended its “disconnection for nonpayment” policy in March 2020. This policy was re-established in May 2021, and disconnections for nonpayment will resume in August 2021. To avoid future late fees or disconnections, you can arrange a payment plan. 

  3. Check box below if you need more time.
  4. Check below if you can't pay your balance in full at once. You will need to pay future bills and an installment amount.
  5. I agree to pay The City of Daytona Beach Utility Billing Department the installment payments as specified in the agreement I am requesting.  I understand that it is my responsibility to pay my monthly utility bill (including installment amount from this agreement) no later than the due date noted on the agreement. Should I not pay my monthly bill in full, I understand my account is subject to penalty fees and disconnection of service until the account is brought current.

    By submitting this form you are requesting a customer service representative contact you to discuss the terms of a payment plan. The payment plan agreement does not go into effect until confirmed by a customer service representative. 

  6. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.



  7. Are you requesting this payment plan arrangement of behalf of someone else?
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  9. This field is not part of the form submission.