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2. Address1
4. City
5. State
6. Zip
8. Phone Number
   Please Include Area Code
10. City Utility Billing Account Number
    Located on Utility Bill
12. 1. Round Up My Utility Bill*

    1. Choosing this option will round up your utility bill to the nearest dollar and donate to the Tip$ fir Trails Program.

    You may choose this option alone, or both Option #1 and Option #2
14. Add This to my Monthly Utility Bill

    1. $1
    2. $2
    3. $5
    4. $10
    5. $15
    6. $20

    Choose an amount to be automatically added to your utility bill each month. You may choose to round up your bill and add an additional donation if you like.
16. Type your Electronic Signature
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field