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2. Virginia Code 58.1-3912(F) allows a taxpayer to choose to receive their tax bills electronically via email. If you wish to receive your tax tickets through email transmission, rather than U.S. Mail, please electronically sign below. 

   E-statements carry the full authority of a regular tax bill.
   
   I wish to receive my tax ticket(s) through email transmission. It is the responsibility of the taxpayer to provide notification of any future change to their email address.

4. Email Address*
6. Tax Account Number(s)/Parcel Number(s)
8. Electronic Signature Agreement*

   By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

   1. I agree.
10. Electronic Signature
11. Date Signed
    Date Signed
Leave This Blank:


13. 1. Receive an email copy of this form.
14. Email address

    This field is not part of the form submission.

15. Submit

* indicates a required field