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Email Bill Consent Form

  1. Authorization*

    I fully understand that it is (utility account holders) responsibility to notify the City of Groveland utility department of any changes to my email address. I fully understand that it is my (utility account holders) responsibility to contact the City of Groveland utility department if I have not received my billing email prior to the first of the month. I fully understand that the utility bill can only be emailed to one email address.

  2. Agreement*

    This agreement is to remain in effect until CITY OF GROVELAND UTILITY DEPARTMENT has received written notification of termination of agreement 30 days in advance.

  3. Important Notice*

    F.S. 119.011 and 119.07 which states"Emails sent to the City of Groveland are subject to public-records requests".

  4. Instructions to Submit the Form

    Print the completed form, attach a copy of voided check, and return to:
    City of Groveland
    156 S. Lake Avenue
    Groveland, FL 34736
    352-426-2141 ext. 221

  5. For Personnel Use Only

  6. Leave This Blank:

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