Request for Payment Plan

Account Basics:

Today's date
Name on Account
First Name
Last Name
Email Address
Phone Number

Service Address:

Street Address
Zip Code

Mailing Address (if different from Service Address):

Street Address
Zip Code

Payment Calculator:

Account Balance *
Payment Term (Maximum of 18 months)
Monthly Payment Amount (Not including new charges; any new charges incurred will be in addition to this amount.)

* Account balances can be accessed via Invoice Cloud or by calling KCWD90 at (425) 255-9600


To satisfy my account balance, I agree to make a payment to KCWD90 by the day of every month, beginning on , until my account balance is paid in full. I agree to pay my account in full within month(s).

I understand that I will continue to be billed the regular, bi-monthly charges, plus the agreed upon monthly amount on my Payment Plan. As the account holder, I understand that I am responsible for the amount due on my account.

In consideration of the above, and in compliance with Washington State's Guidelines regarding Post Expiration of Proclamation 20.23, KCWD90 will not pursue, and will essentially put on hold, any collection action against me, for as long as said Guidelines remain in effect. If/when said Guidelines are no longer in effect, I understand that if I default or breach this agreement, KCWD90 may pursue its right to collection action up to and including foreclosure. I understand that I am in default if a payment is returned as insufficient funds (NSF) or is 45 days late.

If I need to revise this Payment Plan for any reason or if I am unable to make the agreed-upon payments set forth above, I agree to communicate this to KCWD90 immediately in writing or by phone.

By typing my name below, I acknowledge my understanding and acceptance of this Payment Plan.

Electronically Signed by:
Date signed:

Please leave any detailed notes that were not able to be specified above.