E-Billing Enrollment Authorization and Agreement
I, the customer identified below, authorize the City of Valparaiso to enroll me in paperless E-Billing which consists of receiving an electronic bill, via email, for monthly cable and/or utility services provided by the City. In addition, I understand E-Billing enrollment authorizes the City of Valparaiso to discontinue mailing paper bills.
Business Name (Optional)
Street Address Line 2
State / Province
Postal / Zip Code
Cable Account No.
Non-cable subscribers, enter zero
Utility Account No.
Confirm the email address of the E-Bill recipient
Enter the letters as displayed
Should be Empty: