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

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19. Submit Submit and Print

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