Form Builder

Champlain logo

Required fields are marked with asterisks (*)


Application Form for Utility E-Billing

Champlain Township Logo

  • It is the client’s responsibility to notify the Township of Champlain of any changes to the e-mail address provided for e-billing.
  • It is the client’s responsibility to notify the Township of Champlain if the utility bill is not received. (If the electronic bill is undeliverable, a paper copy of the bill will be sent to the client’s mailing address.)
  • I/We understand that I/we will not automatically receive utility bills by regular mail, or hand delivered and that failure to receive a bill via e-mail does not excuse me from the responsibility of payment of my account nor relieve me from the liability of penalty for late payments.

You consent that your electronic signature has the same legal and moral effect as if you signed in ink and will be deemed valid, authentic, enforceable, and binding.

Please try to match your signature as closely as possible so that your application is valid. An X or a dot will not be considered a valid signature. You can clear your signature and start over as many times as you like by clicking on the CLEAR button at the bottom right of the box.


Please review all of the information. If the answers are correct, then click submit. If the answers need editing, adjust the answers accordingly.

After clicking submit you should receive an email (to the email address that you put on the form) with your application form.

Contact Us