Hulbert Public Works Authority 
Email Billing Opt-Out Form
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Account Number  *
Service Address *
Terms and Conditions *

REVOCATION OF AUTHORIZATION AGREEMENT 

I hereby revoke my authorization for the Hulbert Public Works Authority to email my bill.

 

By revocation of this service, I understand that I will no longer receive an email statement, and will receive a paper statement through the United States Postal Service. 

 

In the event that my address changes, I understand that I am responsible for notifying the Hulbert Public Works Authority in a timely manner. I also understand that I am responsible for any late fees that may be incurred due to the inability to deliver a bill to an invalid address. 

Failure to receive a utility bill is not a valid reason for non-payment If you have not received your bill by the third of the month, please contact our office. To view current amounts due, please visit our website at TownofHulbertok.gov 

Upon reauthorization customers are NOT eligible to receive the $10 bill credit. This credit is limited to one credit per lifetime of account. Final consideration is to be determined by the Hulbert Public Works Authority. This credit may be denied at the discretion of the Hulbert Public Works Authority. 

 

 

Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Town of Hulbert.

Does this form look suspicious? Report