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PLC:

a00496

Agency:

city of ellsworth

For:

utility payments

Phone:

515-836-4751

Address:

1528 dewitt street
ellsworth, iowa 50075

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*Name on the Bill:

Middle:

*Last:

*Billing Address:

*City:

*State:

*Zip:

Account Number:

Payment Amount

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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