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2. Courtesy Notification

   City of Belleview utility customers have the option to receive reminders of past due amounts via voice calls, text messages and emails. The City's billing company will send out these reminder notices to customers. The City cannot guarantee that all notices will be successfully sent or received. These reminders are only generated to those customers who have submitted the request form.

4. OPT-IN

   I would like to receive a payment reminder via the following way(s). (Choose one, two or three means of notification). By providing my phone number below, I am accepting automated calls and/or text messages on behalf of the City of Belleview. By providing my email address below, I am expressing my desire to receive email reminders. I may opt out at any time by contacting the City of Belleview. 

6. Voice Calls:

   1. IVR Voice Calls
7. Phone Number
9. Text Message:

   1. Text Message
10. Phone Number
12. Email:

    1. Email
13. Email Address

    The City cannot and does not guarantee that all emails sent will be received by the recipient's email box.

15. Utility Account Number
16. Service Address
18. First Name
19. Last Name
21. Additional Information

    Bills are due the 20th of each month. The City posts notices on Facebook and the information sign in front of City Hall to remind customers of their utility payment due. You can access your bill through our City website, www.belleviewfl.org, by following the Bill Pay link. The City's website also offers the Notify Me feature for Utility Bill reminders. Bills are due the 20th of each month. Failure to receive the bill does not excuse non-payment and service may be disconnected.

23. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
25. Electronic Signature
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field