Form Center

2. PDF Version

   Download PDF Version of E-Billing Form (PDF)

6. Utility Account Number*
7. How do you want to receive your bill?*

   1. E-Bill Only

   1. E-Bill & Paper Bill
9. First Name*
10. Last Name*
12. Service Address*
14. City*
15. State*
16. Zip Code*
18. Home Phone Number
19. Cell Phone Number
21. Email Address*
22. Additional Email Address
26. E-Bill Approval*

    I, the owner/tenant of the above property service address, authorize the Bluffton Utilities to initiate electronic utility bills via email for the account listed above. I acknowledge that it is my responsibility to notify the Bluffton Utilities of any changes in the email address. Failure to receive a statement or update an email address does not exempt me from the responsibility of making payment. I understand by approving this service I will no longer receive a mailed paper statement.

    1. I authorize, acknowledge, and understand.
30. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
32. Owner's Signature*
33. Date*
    Date
35. Tenant's Signature
36. Date
    Date
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field