Required fields are marked with asterisks (*)

Paperless Billing Sign-up Form

Fields marked with (*) are mandatory

Name of Applicant:

Name of Property Owner or Account Holder:

Mailing Address:

Primary Phone Number:

Email Address

I would like to have paperless billing sent directly to the following email address:

Please Note: The onus is on the account holder to advise the Township of Essa if there has been a change in the email address registered for paperless billing.

Please check which services you would like to register for paperless billing:

Property Taxes

Water and Sewer

I acknowledge that by signing this form below, I will no longer receive paper tax and/or water and sewer bills in the mail. I understand that I am responsible for all tax and/or water and sewer amounts billed to my property, regardless if an invoice is received, and that if not paid by the due date, late payment penalties will accrue.

Date:

Signature of Account Holder:

Clear

Personal information contained in this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), and will be used only for the purpose for which its collection was intended. Questions about this collection should be directed to the FOI Coordinator at the Township of Essa.