Municipal Profile

MUNICIPAL INFORMATION

Municipal Name:
Physical Address
Address:
City:
State/Province: Select: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ------Canada------ Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
ZIP/Postal Code:
Country: United States Canada
Bill Payment Address ( check if same)
Address:
Address 2:
City:
State/Province: Select: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ------Canada------ Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
ZIP/Postal Code:
Service Details
Customer Service Phone:
Customer Service Email:
Population (approx):
Are you a member of your State Rural Water Association?
Yes     No
Do you currently accept Online Bill Payments?
Yes     No
Are you interested in getting set up for Online Bill Payments?
Yes     No
Are you non profit/tax exempt?
Yes     No
Email Tax Exempt Form or CCN Cert.?
Yes     No
Transfer existing site content? (Additional Charges Apply)
Yes     No Current Website Address:

ADMIN INFORMATION

This information is for our internal use only. It will not appear on your website.

Your Name:
Your Phone:
Your Email:
Desired Password:
Confirm Password:

Internal URL

https:// .municipalimpact.com
Note: You also have the option to use a custom domain, ex: mytown.com. Instructions to redirect your domain to your new site will be included in a follow-up email as soon as your new website is launched.

How did you hear
about us?: