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PLC:

a0032w

Agency:

city of kittitas

For:

utility payments

Phone:

509-968-0220

Address:

207 north main street,p.o. box 719
kittitas, washington 98934

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*Name:

Middle:

*Last:

*Service Address:

*Account #:

Example: xxxx

Payment Amount

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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