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2. 
3. Utility Billing Department
   Authorization for E-Billing
5. First Name*
6. Last Name*
8. Utility Bill Address*
10. Mailing Address*
12. City*
13. State*
14. Zip*
16. Email Address*
    Please double check you have correctly entered your email address.
18. Utility Bill Account Number*
    Your account number can be found on bottom left of your utility bill.
22. BY SUBMITTING, I HEREBY AUTHORIZE THE CITY OF BROWNWOOD TO E-BILL MY MONTHLY UTILITY BILL. I AGREE, AS THE ACCOUNT HOLDER IT IS MY RESPONSIBILITY TO NOTIFY THE CITY OF BROWNWOOD IF ANY CHANGES TO MY EMAIL ADDRESS NEED TO BE MADE.
24. Signature*
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field