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E-Billing Enrolment Form

Water/Sewer Account #:

Tax Roll #: 42-07-

Name:

Service Address:

Phone Number:

Effective Date:

Email Address for Billing:

Home Owner (print):

Date:

Monthly E-Billing Terms and Conditions
1. Utility and Tax bills will be emailed to the Applicants email address at the time the utility and tax bills are processed.
2. It is the responsibility of the Applicant to monitor whether or not they have received their utility and/or tax bill by email. A HARD COPY OF UTILITY AND TAX BILLS WILL NOT BE MAILED.
3. E-bills may be paid by pre-authorized payment plan, internet banking, or in person at the Municipal Office located at 185667 Grey County Road 9, Dundalk, ON N0C 1B0.
4. Applicants are responsible for advising the Township of Southgate, in writing, of any changes required, including Applicant information, account information, sale of the property, cancellation of the e-billing.

Please select the following accounts that you would like emailed to you:

Please sign to confirm you understand the above E-billing Terms & Conditions.

Signature:

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