eBill 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. Business / Account Name

11. Address

13. City

14. State

15. Zip Code

17. Phone Number

18. Account Number*

20. Email Address*

21. I confirm my subscription to the City of Apopka’s weekly email newsletter.*

    1. Yes

    1. No

    The newsletter will be delivered to the email on this account. To unsubscribe visit http://www.apopka.net/list.aspx.

23. 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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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field