Recurring Donation Authorization Form

City Services billing customers can use this form to authorize voluntary recurring donations on their monthly bill.

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Billing Customer Name *

Account Number *

Customer Number *

This number is listed to the right of your account number.

Customer Email

To be used to send a receipt of this request for your records.

Voluntary Park Donation

Voluntary Library Donation

Voluntary Low-Income Assistance Donation

Other Donation

If you selected "Other" for any of the donation options above, please use this space describe the amounts and where you would like them to go.

Digital Signature

I authorize the City of Corvallis to charge recurring donations to my City Services Account for the programs designated above.

Customers may cancel voluntary recurring donations at any time by calling 541-766-6949 or writing to City of Corvallis Billing Services, PO Box 3015, Corvallis, OR 97339-3015.

Recurring Donation Authorization Form

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