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.