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City of Emporia

info@ci.emporia.va.us

201 South Main Street, Emporia, VA, 23847, US

Contract for Utility Services

201 South Main Street
Emporia, Virginia 23847

“The information regarding race, ethnicity, and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Utilities Service that the Federal laws prohibiting discrimination against applications on the basis of race, color, national origin, religion, sex, familial status, age, and disability are complied with. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity, and sex of individual applicants on the basis of visual observation or surname.”

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.