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2. First Name*
3. Last Name*
5. Property Address*
7. Mailing address if different
9. City
10. State
11. Zip
13. Phone Number*
15. BILLING OPTION:
17. Enter your e-mail address if you would like your water / sewer bill e-mailed to you. This will be in lieu of the full page bill you receive in the mail.
19. E-mail Address
21. RECURRING AUTO PAYMENT OPTION:
24. Authorize the City of Davison to withdraw full water / sewer payment from your bank account, starting with your next quarterly bill.

    If you wish to take advantage of this option, please complete the banking information below. This is for future payments only!

26. Bank Name
27. Checking or Savings
29. Bank Account Number
30. Bank Routing Number
32. Authorization Signature*
33. Date*
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

* indicates a required field