Opt Out Form

Print
Press Enter to show all options, press Tab go to next option
Please correct the field(s) marked in red below:

If you prefer to opt out of actual use billing and remain on sewer averaging, please complete the information below. By submitting the information in this form, you are choosing to have your sewer usage billed based on your average water use.

First Name
 *
Last Name
 *
Phone
 *
Email
 *
Ankeny Utility Billing Account #
Address
 *
Zip code
 *
Confirmation
  1. To receive a copy of your submission, please fill out your email address below and submit.
    CAPTCHA
    Change the CAPTCHA codeSpeak the CAPTCHA code
     

    Please contact Municipal Utility Billing Customer Service with any questions, 515-963-3565.