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2. Existing eBill Customer?

   1. This is information update only

   Please check if you are an existing eBill customer, and only updating your information. Otherwise, please complete the entire form.
4. Company Name
   Please provide company name as it is shown on your RVRA account.
6. Account Number
   Please provide your RVRA account number
8. Primary Contact Name
   Please provide name of person who can answer payment questions
10. Primary email address
    Email address for Primary Contact
12. Primary Phone Number
    Phone number, including area code, for primary contact
14. Secondary Contact Name
    Please provide name of person to contact if primary is unavailable
16. Secondary email address
    Email address for Secondary Contact
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field