PAYMENT ARRANGEMENT AGREEMENT

Licking Valley RECC offers two options to sign up for a payment arrangement.  

Option 1 – Complete the online application below.  This does require you to upload a valid Drivers License for proof of identity.  Sending personal information over the internet is never 100% secure.  Please do not include your full Social Security Number.  We will call you once we receive your application for the payment arrangement and get the remainder of your information at that time.

Option 2 – Drop in our Business office in West Liberty during normal working hours.

Valid Account # must be provided.

Applicants Information

Click or drag a file to this area to upload.
Use this location to upload a copy of your DL. If you wish to provide this in a more secure manner, it can be brought by our business office.

Current Mailing Address

Digital Signature