City of Nampa Form Center

2. 
4. NAMPA SHARES AND CARES PLEDGE
6. Tax-deductible donations will be used exclusively to help less fortunate Nampa residents with their city utility bill. More information can be found on the utility webpage, http://www.cityofnampa.us/index.aspx?nid=140
8. Please add the amount indicated to my bi-monthly bill.
10. Donation Amount

    1. $1

    1. $2

    1. $5

    1. Other
11. Enter Other Amount
13. Acknowledgement
    I understand this amount will be added to each of my bills until I call the office and cancel this bi-monthly donation. This additional charge will start on my next billing. I acknowledge that by typing my first and last name below it will be considered my signature, which authorizes this additional charge to be added to my utility bill.
15. 1. Check here to agree
17. Name
20. Service Address
23. Account Number
26. Phone Number
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field