City of Topeka | Water RoundUp Contribution Form

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Tamara Whorton, Customer Service Manager Topeka, KS 66606 785-368-3111 Tel 785-368-3825 FAX twhorton@topeka.org	Water Contacts

Water - Stormwater - Wastewater - Refuse

Yes, I would like to make a tax-deductible contribution to the Water RoundUp program to help local charitable agencies assist those less fortunate in our community with their combined City of Topeka Utility Bill.

Name:

Service Address:

Phone:

Utility Bill Account # (if known):

I want to make a tax-deductible contribution of: (choose one of the two below)

OR: (please specify)

I understand that I will be billed this amount each month on my City of Topeka Utility Bill, and I can stop contributions at any time.

Please click the 'submit' button below to send your completed form electronically. Otherwise, please print, complete and either:

send by mail to Topeka Water, P.O. Box 1518, Topeka, KS 66601
fax to 785-368-3825
enclose with your next combined City of Topeka Water Bill

Thank You for Participating in Water RoundUp

Last Updated: Thursday January 03 2008

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