2. Date*
   Date
3. City of Llano account number*
5. First Name*
6. Last Name*
8. Address1*
10. Email*
12. How would you like to receive your monthly bill?*

    1. Mail

    1. Email
14. How would you like to receive late notices?*

    1. Mail

    1. Email
16. How would you like to receive cutoff notices?*

    1. Mail

    1. Email
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18. 1. Receive an email copy of this form.
19. Email address

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20. Submit

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