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Residential Utility Billing Agreement

  1. Full Color Logo with Tagline
  2. Type of Resident
  3. Weekly Frederick Flash email letter!

    Stay connected with the Town by receiving our weekly email newsletter.

  4. By typing in my name on this form below, I acknowledge and allow the Town of Frederick to contact me regarding any maters regarding my account including by phone, email and/or automated service.
  5. ***A $10.00 Connection Fee will be applied to the first month's billing statement.***
  6. ****For Office Use Only****
  7. Leave This Blank:

  8. This field is not part of the form submission.