Everyone needs a little help now and then. If you are facing a situation where you can't pay your bill in full by 5:00 p.m. on the day before cut-off day, which occurs monthly on the 20th, please submit an extension request. You may do so by completing our online form (see below), or you may call City Hall to complete a form over the telephone, or receive a form via email, or you may come in to City Hall.

All extension requests will be determined on a case-by-case basis.

Preference will be given to extension requests that meet the following criteria:
• Submitted by the account holder or family member.
• Submitted BEFORE the cut-off date.
• Account holder has had service at least 3 months.
• Account holder has no disconnects within the last 6 months.
• Account holder has not had a returned check within the last 12 months.

Please contact us if you need further information: (405) 547-2445

Please allow 24 business hours for processing.

Account Holder Full Name*

Account Number (not required)

Service Address*

Account Mailing Address*

Your Name*

Your Relation to Account Holder*

Your Cell Telephone Number (include area code)*

Account Balance (not required)

Cut-off Date (not required)

Requested Extension Date*

Can you pay any amount now? If yes, how much?*

Reason for Request *

I understand and agree that the entire past-due balance on this account will be paid by 5:00 p.m. on the extension date as approved by the City of Perkins.

I further understand that if payment is not received as indicated above, services will be disconnected without further notice and a $25.00 disconnect fee will be applied to the account. To restore services, the entire past-due balance plus the $25.00 disconnect fee, and a $25.00 reconnect fee will need to be paid.

I understand that if this extension agreement is broken, no further extensions will be granted for 12 months.

Yes, I agree

By typing your name below, you are attesting that you are the account holder or that you are acting with the account holder's full knowledge.

Electronic Signature (to confirm your request)*

Today's Date (MM/DD/YYYY)
*

Sometimes technology has glitches. If you have not heard from us within 24 business hours of submitting your form, please call us at (405) 547-2445. *

Yes, I understand