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Water/Sewer Community Assistance Program Enrollment Form

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Account #*
Name*
Service Address*
City*
State*
Zip Code*
Phone Number*
Email Address*
Please Select One Option*
1. One Time Donation
2. Recurring Monthly Donation
One Time Donation of:
Recurring Donation of:
I authorize the Town of Boone to add a Community Contribution to my water/sewer bill as indicated above. I understand I may revoke this authorization at any time by submitting a 30-day written notice to the Town of Boone, Utility Billing & Collections department.
Signature*
Date*
Date