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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:

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, 3245 NW Water Works Dr, Topeka, Kansas, 66606

fax to 785-368-3825

enclose with your next combined City of Topeka Water Bill

Thank You for Participating in Water RoundUp

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