Cypress County - Utilities E-billing Sign Up

Utilities E-billing Sign Up

<form-template>
	<fields>
		<field type="text" subtype="text" required="true" label="First Name" class="form-control text-input" name="text-1535726515660"></field>
		<field type="text" subtype="text" required="true" label="Last Name" class="form-control text-input" name="text-1535726543302"></field>
		<field type="text" subtype="text" required="true" label="Mailing Address" class="form-control text-input" name="text-1535726570376"></field>
		<field type="text" subtype="text" label="Address 2" class="form-control text-input" name="text-1535726594082"></field>
		<field type="text" subtype="text" required="true" label="City / Hamlet" class="form-control text-input" name="text-1535726620290"></field>
		<field type="text" subtype="text" required="true" label="Province" class="form-control text-input" name="text-1535726655268"></field>
		<field type="text" subtype="text" required="true" label="Postal Code" class="form-control text-input" name="text-1535726696656"></field>
		<field type="text" subtype="text" required="true" label="Phone Number" description="Ex: (403) xxx xxxx" class="form-control text-input" name="text-1535726763193"></field>
		<field type="text" subtype="email" required="true" label="Email Address" class="form-control text-input" name="text-1535726923121"></field>
		<field type="text" subtype="text" required="true" label="Utility Account Number" class="form-control text-input" name="text-1535726951793"></field>
		<field type="text" subtype="text" label="Service Address (if different than mailing address)" class="form-control text-input" name="text-1535726971032"></field>
		<field type="textarea" label="Other Information" class="form-control text-area" name="textarea-1535727022199" value="**This personal information is being collected under the authority of Alberta’s Freedom of Information and Protection of Privacy Act (FOIP). Pursuant to section 33(c) of the FOIP Act the collection is related directly to and is necessary to deliver programs and provide services at the Cypress County. Cypress County only uses this information for the purposes for which it is collected and has the highest respect for the privacy and confidentiality of personal information. If you have any questions about the collection of information, please contact us at utilities@cypress.ab.ca, or by phone at 403.526.2888"></field>
	</fields>
</form-template>

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Municipality of Cypress County

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Utilities E-billing Sign Up

Utilities E-billing Sign Up