Senior Citizen Water Billing Discount Application

The City of Portage offers a ten (10) percent discount on water services for persons 65 years of age or older. The discount is applicable only to the customer’s primary residence in which the customer is billed directly. The discount is applied to the water base quarterly charge and water usage charge for City of Portage provided water. No discounts shall be applied to sewer charges.

After completing this form, print and sign the application then mail or deliver the form and proof of age (copy of driver license) to the City of Portage Treasury Office, 7900 South Westnedge Avenue, Portage MI 49002.

Phone Number:

Email:

Date of Birth (00/00/0000 - Month, Day, Year):

Driver License Number & State:

By affixing my signature, I hereby state that the information I have provided in this application is true and correct. I agree to provide proof age eligibility. I understand that if I receive the Senior Citizen Water Billing Discount by using misleading or false statements, I may be required to pay back the utility subsidy I received. I understand that this information is used solely to determine eligibility for the Senior Citizen Water Billing Discount.

I hereby request a ten percent (10%) Senior Citizen Water Billing Discount on water charges at my homestead.

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

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