2. Customer Name*
4. Service Address*
6. Service Mailing Address (if different)
8. Account Number*
10. Phone Number*
    xxx-xxx-xxxx
12. Email Address*
16. I authorize Georgetown Charter Township to send my Water/Sewer Bill electronically to the email address listed above. I understand that a paper bill will no longer be mailed to the service mailing address, and if at any time I decide to discontinue the electronic billing service, I will notify Georgetown Charter Township two weeks before the next bill is sent. By typing your name in the space below you are agreeing to discontinue paper billing and only receive Water/Sewer Bills via email.
18. Full Name*
19. Date*
    Date
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field