E-Billing Authorization

2. Town of Normal – E-Billing Notification Authorization Form

4. Date:*

6. Name:*

7. Address:*

9. City:*

10. State:*

11. Zip Code:*

13. Telephone:*

14. Town of Normal Account Number*

    (Exactly as it appears on your bill)

16. Email Address:*

17. Please Re-enter your Email Address:*

19. Customers using the E-Billing Notification service are subject to standard late fees, as well as standard delinquency procedures.<P><br>By submitting this form I agree to accept responsibility to ensure that I am receiving my bi-monthly E-Billing notifications at the email I have provided.

    Customers using the E-Billing Notification service are subject to standard late fees, as well as standard delinquency procedures.

    
    By submitting this form I agree to accept responsibility to ensure that I am receiving my bi-monthly E-Billing notifications at the email I have provided.

Leave This Blank:


20. 1. Receive email copy
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field