Utility Forms

To find forms related to City of Bend utility assistance programs, please click here to go to the Assistance Programs page.

Automatic Payment (Bank Draft) Authorization Form

The City offers the ability to have your utility bill(s) automatically deducted from a checking or savings account. It is easy, and it saves you time and money. There is no longer a need to write a check and send it to the City. You will still receive your regular monthly utility bill, indicating the amount to be drafted from your bank account. Bank-draft dates vary. For your specific bank draft date, please call Utility Billing Customer Service at (541) 388-5515. It can take up to two months for your automatic deduction to begin.

Automatic Payment (Bank Draft) Authorization Form


Landlord Agreement Form

Landlord Agreements revert utility billing back to the property owner until an account is opened in the name of a tenant. For questions about landlord agreements, please call (541) 388-5515.

Landlord Agreement Form


Winter Quarter Average (WQA) Adjustment/Appeals

Requests for Winter Quarter Average (WQA) appeals may be made by contacting City of Bend Billing and Customer Service Department at (541) 388-5515 or by completing the WQA Adjustment/Appeal Request Form and submitting it with required documentation and within 120 days from bill date where WQA change occurred, as outlined in the WQA Adjustment/ Appeal Process instructions.

Please download the appropriate request form and follow the instructions

Winter Quarter Average Adjustment/Appeals Form (English)

Winter Quarter Average Adjustment/Appeals Form (Spanish)

Leak Adjustment Request

Requests for water Leak Adjustments may be made following the repair of a leak. Customers must make reasonable efforts to locate the leak and initiate repairs within 30 days of the City’s notification or following a noticed increase of usage appearing on monthly bills. The account may qualify for a billing adjustment after a review of the account concludes that a leak existed and that the leak had a negative impact on the amount billed.

Leak Adjustment Request Form (English)

Leak Adjustment Request Form (Spanish)

Transportation Fee Appeal

A request for fee review and adjustment may be granted or approved by the City Manager only when one or more of the following conditions exist:

1. The amount charged is in error, including assignment of the property to a residential or nonresidential category, the square footage or other unit base of a nonresidential property, and the use categorization for nonresidential property;
2. The parcel exists in its natural unimproved condition, is not connected to the City’s stormwater or sewer system, is not connected to any domestic or irrigation water service, and will remain in its natural unimproved condition with no allowable human activities or improvements that would generate trips, whether automobile, or by any other means of conveyance, over the City transportation system, to or from the parcel.

Transportation Fee Appeal Form (English)

Transportation Fee Appeal Form (Spanish)

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