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Round Up Registration

2. Brighton Customer Assistance Program Round Up
   How it works: Roundup your monthly statement to help those in need in your community. When you round up your monthly statement to the nearest dollar amount these funds will be set aside to assist other residents facing a temporary financial crisis. Roundup amounts will never total more than $12 annually but your contribution is greatly appreciated!
4. Enroll Now:
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Account Number*
19. Phone Number*
21. Email
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23. 1. Receive an email copy of this form.
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