Senior Citizen Discount | Utility Billing

2. 
4. Richton Park is proud to offer our Seniors an $8 discount off of your bi-monthly utility bill!
   Must be at least 65 years of age to take advantage of this deduction. Please provide a valid form of identification before completion.
6. First Name*
7. Last Name*
8. Date of Birth*
   Date of Birth
10. Service Address*
11. Phone Number*
13. Form of ID*
    -- Select One --Drivers LicenseState IDU.S. Passport
14. ID Number*
16. Image of Form of ID
17. Electronic Signature Authorized*

    1. Yes
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit Submit and Print

* indicates a required field