Deferred Payment Request

Deferred Payment Request

If your family is experiencing a hardship that is directly related to the COVID-19 Pandemic, HCWA would like to offer you a “Deferred Payment” option. In order to be considered for deferment, simply complete the information below and submit this form, along with appropriate documentation.  Information can be submitted via this form, or mailed to the HCWA address below, attention: Customer Service Department.

Information required:

  1.    Completed and signed request form (Electronically via this page or download and mail in this form).
  2.     Verification of one of the following:
    1.  A separation notice from your employer indicating you have lost your job.
    2. Documentation that you meet any of the applicable criteria stated in the recently enacted “Families First Coronavirus Response Act”.  
    3.  A notice from DOL stating you are receiving unemployment
    4.  Letter from employer indicating reduced hours
    5.  Letter of explanation stating circumstances

If approved, HCWA will defer (postpone) the payment for the requested month.  The amount of the deferred payment will be divided up and added to upcoming bills. For example: A bill amount of $75 is due on April 6th.  $25 would be added to the May, June, and July water bills. 



All request forms must have copy of supporting documentation.  Requests that are incomplete, or missing documentation, will NOT be processed.  All Deferred Payment Requests submitted to Henry County Water Authority (HCWA) will be processed within 3 business days of receipt, and are subject to approval by HCWA before the agreement goes into effect.   Once processed, you will receive an email confirmation informing you of the acceptance of your request, or reason for denial.  Your signature below acknowledges your understanding that once established, payment arrangements do not cover future monthly bills, which are due and payable on or before the due date. Failure to make scheduled installment payments, returned checks, credit card chargebacks, or delinquent current bills will result in the special payment arrangement being declared null and void and disconnection of service may be made with no further notice.

By signing below and submitting this form, I am agreeing to all terms and conditions of this arrangement as put forth by Henry County Water Authority.

Please fill out the form below. Required fields are indicated with a * symbol. Thank you.

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