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Sign-Up for Paperless Electronic Water Bills

2. Sign-Up Request for Paperless Electronic Water Bills
   This is a request to sign up for paperless water bills to be delivered electronically versus a paper bill. Regardless of the process for receiving your bill, it is still your responsibility to ensure that your water bill is paid by the due date. All information provided in this form is subject to Freedom of Information Act requests subject to State law.

   This is a request to sign up for paperless water bills to be delivered electronically versus a paper bill. Regardless of the process for receiving your bill, it is still your responsibility to ensure that your water bill is paid by the due date. All information provided in this form is subject to Freedom of Information Act requests subject to State law.

3. 

5. First and Last Name on Account*

6. Water Account Number*

8. Service Street Address*

9. Zip Code*

11. Phone Number

12. Email Address

16. Mailing Street Address (If Different)

17. Mailing City, State, Zip Code

19. By completing this form, I understand that I will no longer be receiving a paper water bill in the mail.

21. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
23. Electronic Signature*

24. Date*
    Date

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

* indicates a required field