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2. First Name:*
4. Last Name:*
6. Utility Account Number*
8. Service Address (98290 zip code only):*
10. City*
12. Mailing Address if different than service address
14. Email Address:*
16. Home Phone Number:
18. Mobile Phone Number:
20. Preferred Method of Contact
    -- Select One --Home PhoneMobile PhoneEmail Address
22. Would you prefer to receive:
    -- Select One --e-billsPaper BillsBoth
24. ADDITIONAL COMMENTS:
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

* indicates a required field