This application is for customers on a fixed income, which means that they receive one (1) check per month at a scheduled time. You do not qualify if you are employed and receive regular paychecks. You will be subject to late fees, penalty fees, or disconnection of service for nonpayment.
Please insert today's date
You can find the account number on the upper right hand corner of your monthly billing statement. Please provide the full account number including the dash.
Address, City, State, Zip
I understand that if I do not pay by the permanent due date listed above, that my account is subject to: late fees, penalty fees, and that service may be disconnected in accordance to the City of Rio Rancho Ordinances. I also understand that I will need to provide proof that I am on a fixed
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