Utility Billing

2. **Existing Customers Only**
4. Residential/Commercial*

   1. Residential
   2. Commercial
5. Account Number
7. Service Address
9. Business Name
11. First Name*
12. Last Name*
14. Service Address*

    Physical Address where water is served.

16. City*
17. State*
18. Zip*
20. Phone Number*

    Mobile Device Preferred.

21. Phone Type*
    -- Select One --mobileland line
23. Email*
24. Would you like to receive general Town News emails to this email address?*

    1. Yes
    2. No
28. Billing Address
30. First Name
31. Last Name
33. Billing Address
35. City
36. State
37. Zip
39. Emergency Contact Info
41. First Name
42. Last Name
44. Emergency Contact Phone

    Mobile Device Preferred

45. Phone Type
    -- Select One --mobileland line
47. Alternate Contact Email
48. Would you like to receive general Town News emails to this email address?

    1. Yes
    2. No
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field