Sign Up to Give Back
(Community round up program)
By simply signing up to “round up” your monthly utility bill to the nearest dollar you can
make a great, positive impact on our senior community.
So how does it work? If you sign up, your monthly bills will be rounded up to the next highest
dollar. For example, if your bill is $44.25, your bill will be rounded up to $45.00. Making your
contribution $.75 cents. The funds raised from this program will be donated to our local
Meals on Wheels program.
YES, I would like to participate in the ‘round up’ program. I authorize the City to round-up my
Utility bill to the nearest $1 increment each month. I understand I may revoke this
authorization at any time by submitting a 30-day written notice to the City.
Name:________________________________________________________________
Property Address:______________________________________________________
Phone #: ______________________________________________________________
Signature:______________________________ Date:__________________________
Once completed, please return this form via fax @ 636-639-2029,
or by email to [email protected] .
Questions please call 636-327-5101 or 636-639-2155.
310 W Pearce Blvd • Wentzville, MO. 63385
Ph. 636-327-5101 • Fax 636-639-2029
www.wentzvillemo.org