2. Ephrata Borough Budget Billing Application.
4. Full Name*
6. Daytime Phone Number*
8. Account Service Address*
10. Click the appropriate box below:*

    1. Owner
    2. Tenant
12. Name and address of owner
14. Name*
    By entering your name and date above, you are signing this form and agreeing to all terms and conditions of this application.
15. Date*
    Date
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field