E-billing Signup DESTIN WATER USERS, INC. AUTHORIZATION FOR E-BILLINGDestin Water Users Account #(Required)Member's Name(Required) First Last Service Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) List of other service locations and account numbers:Service AddressAccount # Add RemoveElectronic Consent of Delivery(Required)By checking “I agree,” you acknowledge as an e-billing customer, you will no longer receive a paper bill in the mail. Instead, you will receive a monthly electronic billing notification by e-mail. I agreeIf for any reason, we are unable to process your email address, you will automatically receive the standard paper billing. Member will be responsible for providing valid email addresses. You may elect to discontinue e-billing at any time and return to paper billing. Just send a written request via email to **@dw****.com or send the request to DWUINC, PO Box 308, Destin, FL 32540.Signature(Required) 61638