Water & Sewer Paperless Billing Authorization Form

Name (as shown on utility bill):

Service address:

Holland Charter Township account number:

Phone number:

Cell number:

E-mail address:

I authorize Holland Charter Township to e-mail my monthly utility bill and I acknowledge that I will no longer receive a paper bill.

The e-mail will be sent from This email address is being protected from spambots. You need JavaScript enabled to view it. and will include a PDF attachment. I agree that it is my responsibility to review the bill for accuracy and notify the Township of any concerns or questions. I further agree to notify the Township of any changes to my mailing address, e-mail address or contact information. Failure to notify the Township of any changes or failure to receive the bill does not waive penalties or fees and the account will still be subject for disconnection due to non-payment.

This form was created by ChronoForms 8

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Water & Sewer Paperless Billing Authorization Form

Holland Charter Township

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