2. EXTENSION REQUEST FORM

4. General Guidelines

   • Extensions are allowed once every 6 months. 

   • Defaulting in this agreement results in disconnection of services without further notice and a $50.00 administrative fee assessed. 

   • If customer does not pay within 5 calendar days, the deposit shall be applied to the remaining balance. Once the deposit is applied, a new deposit shall be required to initiate new services. 

   • Complete this form in its entirety.

6. Customer Information

8. Name*
9. Account #*
11. Address*
13. City
14. State
15. Zip Code
17. Phone Number*
18. Email Address*
20. Amount Due
21. Due on
    Due on

23. Please Sign and Date Below

25. Customer Signature*
26. Date*
    Date

28. If you have any further questions, please contact the Utility Department at 817-641-3336. 

    You may also print this extension request form, fill it out, and then submit it to Keene City Hall.

    • By mail: 1000 N. Old Betsy Rd, Cleburne, TX 76031

    • Fax: 817-556-2060

    • Email: utilities@keenetx.com

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30. Submit

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