This form is for enrollment in Budget Billing and Automatic Credit Card draft for payment of your utility bill.

Note: Credit card drafts are subject to an additional $2.95 per transaction.

Continue with this form by clicking the "Next" button below.

To enroll in Budget Billing with automatic bank draft payments instead, please click here.

Please check that you agree before continuing.

By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.

Signature HereClick to Sign

04/20/2024Click to Sign

Signature HereClick to Sign

04/20/2024Click to Sign

I.N.Will Update Upon Signing

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

Full Legal Name

Your Initials

Signature Type

Type Draw Upload Custom

Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Additional Signatures Required

	Signer Details	Me?
Account Owner
I'm not a signer listed above

City of Concord Collections

Print Document

Create Your Signature

Sign Now!

Please provide accurate information below to ensure the delivery of the signed copies of the document.

Listed Signers

Other Signers (The signers below will be invited to sign once the above signers have signed.)

Billing