E-Bill Authorization

2. Utility Billing Division
   Telephone: 407-703-1727<br>Fax: 407-703-1630<br>Website: www.apopka.net

   Telephone: 407-703-1727
   Fax: 407-703-1630
   Website: www.apopka.net

4. Date
   Date

6. First Name

7. Last Name

9. Address

11. City

12. State

13. Zip Code

15. Phone Number

16. Account Number

18. Email Address

20. By submitting this form, I hereby agree to no longer receive a monthly bill statement via the US Postal Service. I will receive a notification by e-mail that a new bill has been created and is available for viewing. If my e-mail address changes, it will be my responsibility to notify the City of Apopka Utility Billing Division of the change so I can continue to receive notifications. This will remain in effect until I notify the City of Apopka Utility Billing Division to discontinue. All other policies, collections, penalties or fees of the City of Apopka will remain the same as if a paper bill had been mailed. E-mail addresses are public records under Florida law and are not exempt from public records requirements.

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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

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