Skip to form

Dear Property Owner,

The City of Dayton regularly allows customers to set up payment plans in order to pay installments on their quarterly utility bill. If a customer breaks a payment plan, the water is shut off immediately without any further notification. If a customer breaks 2 payment plans, the water is shut off and that address is not eligible for another payment plan for 12 months from the date of the last broken agreement.

As the property owner, you have the right to require your tenants to pay their utility bill in full each quarter, without access to our payment plans by placing an Owner Block on the account. Once you have placed such a block on an account, it remains in effect until the property is sold. Owner blocks will be removed from the account when we receive verification that the property has been sold. At any time, you have the option to allow a one-time only payment plan or remove the block altogether.

This Owner Block form is used to do either of these actions. Please complete, attach a copy (or picture) of your photo ID and submit. We will process within 1 business day of receipt.

Please contact us at or 937-333-3550 with any additional questions.

Thank you
By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.
Signature HereClick to Sign
I.N.Will Update Upon Signing

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.


Signature Type

Type Draw Upload Custom
Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue


Additional Signatures Required