Voluntary Contribution Authorization

2. Voluntary Contribution Authorization
   I request the City of Weatherford to add a voluntary contribution to my monthly utility bill. I understand this contribution is voluntary and will be administered under the guidelines established by the Board of Directors of Manna Storehouse Inc., and will be used to assist other City of Weatherford utility customers in times of need. I may discontinue this contribution at any time by submitting my request in writing to the City of Weatherford Utility Billing Department.

   I request the City of Weatherford to add a voluntary contribution to my monthly utility bill. I understand this contribution is voluntary and will be administered under the guidelines established by the Board of Directors of Manna Storehouse Inc., and will be used to assist other City of Weatherford utility customers in times of need. I may discontinue this contribution at any time by submitting my request in writing to the City of Weatherford Utility Billing Department.

4. Customer Name

6. Utility Account

8. Contribution Amount

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10. 1. Receive an email copy of this form.
11. Email address

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12. Submit

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