E-Billing Town of Battleford Application Form <form-template> <fields> <field type="text" subtype="text" required="true" label="First Name" class="form-control text-input" name="text-1585159681906"></field> <field type="text" subtype="text" required="true" label="Last Name" class="form-control text-input" name="text-1585161796666"></field> <field type="text" subtype="text" required="true" label="Service Address" description="Civic Address" class="form-control text-input" name="text-1585160017189"></field> <field type="text" subtype="text" required="true" label="Utility Account Number" description="You can find your account number in the top left corner of your invoice." placeholder="12 digit account number (the zeros matter)" class="form-control text-input" name="text-1585160090603"></field> <field type="text" subtype="text" required="true" label="Phone Number" class="form-control text-input" name="text-1585160141597"></field> <field type="text" subtype="email" required="true" label="Email Address" description="The Town will be contacting you by email, please provide an email that you are most likely to use." class="form-control text-input" name="text-1585160192901"></field> <field type="date" required="true" label="Date" class="form-control calendar" name="date-1585160414529"></field> <field type="textarea" required="true" label="Signature" class="form-control text-area" name="textarea-1722368809211"></field> <field type="checkbox" required="true" label="By submitting this form I agree to the Town of Battleford eBilling terms and conditions" class="checkbox" name="checkbox-1585160270440" value="Terms and Conditions Agreement"></field> <field type="paragraph" subtype="p" label="Town of Battleford Utility E-Billing Terms and Conditions Town of Battleford Utility E-Billing Terms and Conditions When enrolling in the e-billing service, you agree to receive an electronic bill in place of your paper bill from the Town of Battleford. If applicable, e-billing customers are subject to the standard non-payment procedures and fees. All reminder and final bills will be sent by paper based mail. " class="paragraph"></field> <field type="paragraph" subtype="p" label="You must have a valid e-mail address to use e-billing and provide us with that address. The privacy and accuracy of that e-mail address is entirely your responsibility. It is your responsibility to ensure that your junk mail filters allow mail to be received from utilityebill@battleford.ca. Should your e-mail address become invalid or if you want your bill sent to another e-mail address or if your service address changes, it is your responsibility to notify the Town of Battleford by filling out a new application. " class="paragraph"></field> <field type="paragraph" subtype="p" label="If you wish to cancel e-billing you must notify our office. Any change or cancellation does not terminate any obligation to the Town of Battleford. The Town of Battleford reserves the right to refuse the e-billing service to anyone, for any reason, and to modify or discontinue the e-billing service at our discretion. If you have any questions, contact our office at (306)937-6200. " class="paragraph"></field> </fields> </form-template> Submit Submitting...
