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Email Authorization Form

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  2. CITY OF LE MARS UTILITY DEPARTMENT
    EMAIL AUTHORIZATION FORM
  14. Email All Utility Bills
    If you are a business or have more than one account in your name indicate by checking the box, then scan and upload a copy of each bill.
  21. I hereby authorize the City of Le Mars to email my utility bill for water, sewer and garbage fees until revoked by me in writing to City of Le Mars, 40 Central Avenue SE, Le Mars, IA 51031. I understand that I must contact the City of Le Mars concerning any changes with my email address. City of Le Mars will have thirty (30) days to change my email address.
  23. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
    27. Leave This Blank:

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