Round Up Your Utility Bill

2. First Name

3. Last Name

5. Address1

7. Address2

9. City

10. State

11. Zip

13. Account Number

15. By submitting this form, you are authorizing the City of Pierre to round your monthly utility bill up to the next whole dollar amount. Your Round Up Donation will begin and continue monthly. You may opt out of the program at any time by contacting the City of Pierre at 605-773-7407.

    By submitting this form, you are authorizing the City of Pierre to round your monthly utility bill up to the next whole dollar amount. Your Round Up Donation will begin and continue monthly. You may opt out of the program at any time by contacting the City of Pierre at 605-773-7407.

Leave This Blank:


16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit Submit and Print

* indicates a required field