Special Payment Arrangement Form

Special Payment Arrangement Request

Terms and Conditions: 

All Special Payment Arrangement 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.   By submitting this request, you acknowledge your understanding that once established, payment arrangements do not cover future monthly bills, which are due and payable on or before their 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, your service may be INTERRUPTED IMMEDIATELY, WITHOUT FURTHER NOTICE, and additional fees may apply.  Failure to honor your arrangement may also result in denial of future requests.  If service is cut off for a broken payment arrangement, you may be required to pay the total account balance, including all fees and additional security deposit (if required), to restore service.  

Submission of this request will not prevent disconnection of service.

By 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!

* Cell Phone Number
* May we send you text notifications?

* May we send you e-mail notifications?

* Would you like to make your payment on your regular bill due date?