[Sevierville, TN] Payment Arrangement Request Form

A Payment Arrangement is an agreed-upon plan for paying your account balance (current or past due) on or before a specified date.

Payment arrangements must be submitted no later than 5pm the day before a service disconnect to be considered.

Do not submit this form if your water has been disconnected. Please contact us directly at (865) 453-5522.

Contact Information

Cell Phone Number

Home Phone Number

Account #

I am requesting the City of Sevierville accept the following arrangement:

Payment Date

Payment Amount

Payment Date

Payment Amount

Reason for Request

Important Information

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Date