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2. Note
   Paperless billing will begin (or be discontinued) by filling out this form. The service starts (or ends) with your next quarterly utility bill. Please contact the Treasury Office at 269-329-4455 with any questions.
4. Utility Account Holders' Name
5. Email Address
7. Address (Where utility services are received)
9. City
10. State
11. Zip Code
13. Daytime Phone Number
17. Mailing Address
19. City
20. State
21. Zip Code
25. Do you wish to initiate or discontinue paperless billing?

    1. Initiate
    2. Discontinue
27. Do you wish to continue receiving a paper bill?

    1. Yes
    2. No
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field