E Bill Authorization

Please fill out and submit the following form if you would like to receive a copy of your utility bill electronically instead of via USPS.

Full Name * : 

Street Address * :

Email * : 

Daytime Phone * :


 I authorize the City of Adrian to deliver my monthly utility bill to the above valid active email address. I understand that I will no longer receive a paper bill in the mail once this service is started, and I can discontinue this service by notifying the Utilities Department in Writing.