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2. By signing and returning this authorization, I give the Garland County Tax Collector approval to email statements and/or delinquent notices.

4. I would like to receive statements and/or delinquent notices.

   1. Yes
   2. No

6. Name

7. Pin

9. Address

11. City

12. State

13. Zip Code

15. Phone Number

16. Email Address

18. Signature

    By typing your name into this field you authorize Garland County to consider this an electronic signature.

19. Date
    Date

21. I understand I will not receive a paper statement. If my email address changes I'll notify the collector's office.

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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field