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2. Statement of Agreement

   I/We , the undersigned, will not hold, The Public Works Department, Billings, Montana, responsible for any damage incurred if the TENANTS/OCCUPANTS are not home, IN ALL UNITS, when the water is turned back on after being shut off.

   1. I Agree to Hold Harmless
4. Name*
6. Address*
8. City*
9. State*
11. Zip Code*
13. Phone Number*
14. Email Address
16. Signature Acknowledgement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I Agree to use an Electronic Signature
18. Electronic Signature*
    Enter your full legal name
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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