The City of Tallahassee

Please complete the form below to sign up for the Change for Change program. By completing the form below, you are certifying that you are the primary City utilities account holder and that you wish to make a monthly donation to help homeless families and individuals in the community. Please fill out the form completely. Within the next week, you will receive an email at the email address on file for your account (if provided) or a letter mailed to the address on file for your account that confirms your enrollment in the Change for Change program.

Change for Change Signup Form

All fields are required

First Name:
Last Name:
Street Address:
Zip:
Last 4 Digits of Social Security Number (To Verify Account Holder):
Email:
Phone Number:

Monthly Contribution: $1 $3 $5Other
If Other, how much would you like to donate monthly? $

YES! I'd like to participate in the Change for Change Program. I hereby authorize the City of Tallahassee to add the amount indicated above to my monthly utility bill and continue until I notify the City that I no longer wish to participate. I understand that all funds donated go toward support of the program.

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Version: 3074 (6/20/2017 4:16 PM) |