To participate, simply complete the form below. A Customer Service Representative will confirm your registration via a return e-mail. Please allow two business days for processing.
Required fields are indicated with a * symbol.
By hitting "Submit" above, I authorize the Henry County Water Authority to round up my utility bill to benefit the Charitable Assistance Program. I understand that my bill will continue to be rounded up on a monthly basis unless I notify the Henry County Water Authority in writing, via regular mail or email, that I wish to discontinue the program.