You must have JavaScript enabled to use this form. Primary Account Holder: First Name Primary Account Holder: Last Name Additional Name(s) on Account Service Address Address (Street Number, Unit Number, Street Name) City/Town Province Postal Code Service Address Primary Telephone Number Secondary Telephone Number Email Address Email Address Confirm email Mailing Address Same as Service Address Mailing Address Address (Street Number, Unit Number, Street Name) City/Town Province Postal Code Country Roll Number (if known): Water Account Number (if known): Electronic Billing Sign-Up I'd like to receive my water bill by email I'd like to receive my tax bill by email I'd like to receive the Middlesex Centre newsletter via email By selecting to opt into e-billing, I am authorizing the Municipality of Middlesex Centre to transmit all future property tax bills and/or utility (water) bills, as I have selected above, to the email address provided above. I understand that I will not receive these bills by regular mail and that failure to receive a bill does not excuse me from the responsibility of payment nor relieve me from the liability of penalty for late payments. I accept responsibility for contacting the municipality with any future changes in my email address. I agree to sign-up for e-billing.? By selecting to opt into e-billing, I am authorizing the Municipality of Middlesex Centre to transmit all future property tax bills and/or utility (water) bills, as I have selected above, to the email address provided above. I understand that I will not receive these bills by regular mail and that failure to receive a bill does not excuse me from the responsibility of payment nor relieve me from the liability of penalty for late payments. I accept responsibility for contacting the municipality with any future changes in my email address. Leave this field blank
