E-Bill Authorization

Please fill out and submit the following form if you would like to receive a copy of your utility bill electronically instead of via USPS.

Full Name * :

Street Address * :

Provide your Street Address

Email * :

Provide your Email

Daytime Phone * :

Provide your Daytime Phone(XXX-XXX-XXXX)

Date:

I authorize the City of Adrian to deliver my monthly utility bill to the above valid active email address. I understand that I will no longer receive a paper bill in the mail once this service is started, and I can discontinue this service by notifying the Utilities Department in Writing.

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