Round Up
Enrollment Form

Please sign me up for: Round Up       Round Up Plus: $

Utility Account Number:   --
Name:  
Address:  
City, State Zip:
    
Phone:
  ()- -
 


Signature: _______________________________________________

Please be sure to complete this form entirely, print it, sign it and mail to:

Lawrenceburg Utility Systems
ATTN: Round Up
PO Box 649
Lawrenceburg, TN 38464

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