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2. Town of Normal – E-Billing Notification Authorization Form
4. Date:*
6. Name:*
7. Address:*
9. City:*
10. State:*
11. Zip Code:*
13. Telephone:*
14. Town of Normal Account Number*
    (Exactly as it appears on your bill)
16. Email Address:*
17. Please Re-enter your Email Address:*
19. Customers using the E-Billing Notification service are subject to standard late fees, as well as standard delinquency procedures.

    
    By submitting this form I agree to accept responsibility to ensure that I am receiving my monthly E-Billing notifications at the email I have provided.

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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

* indicates a required field