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2. 
3. Water Department
   City of Taylor 23555 Goddard Taylor, MI 48180
7. Water Account Number*
8. Water Account Address*
10. New Mailing Address
12. First Name*
13. Last Name*
14. Phone Number*
15. Email Address*
17. Address*
19. City*
20. State*
21. Zip Code*
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. Please review the City's website privacy policy.

    1. I agree.
25. Electronic Signature*
26. Date*
    Date
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28. Submit Submit and Print

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