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E-Bill Authorization

  1. E-Bill Authorization
  2. I authorize the Borough of Seaside Heights to send the utility bills selected below to me via e-mail only. I understand that, if I select this option, I will no longer receive paper bills. I must notify the Borough of Seaside Heights in writing (not e-mail) if I choose to discontinue e-bill notification. I assume the responsibility for any and all consequences related to the failure to receive any e-bill.
  3. (If you do not want your electric bill sent via e-mail leave this blank)
  4. (If you do not want your water/sewer bill sent via e-mail leave this blank)
  5. By typing your name you are acknowledging that this would be a signature.
  6. Date
  7. Leave This Blank:

  8. This field is not part of the form submission.