Utility Service Application and Agreement

Utility Service Application and Agreement
Instructions: Please complete all sections of the form that apply to you. Please be sure to have the following documents available when opening an account. A deposit is required for all new accounts. Water accounts can only be made in the property owner’s name.
Today's Date*

MonthDayYear

Hour MinutesAM/PM Option
Is this a new account*

YesNo
Is this a residential / commercial account?*

ResidentialCommercial
Proof of Ownership

Upload for All New Services | Max file size: 25 MB, Accepted file types: .pdf, .jpg, .png
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Applicant's Information
Applicant Name*

First NameLast Name
E-mail Address*
example@example.com
Contact Number*
Add your best contact to reach you.
Is the service address the same as the billing address?*

YesNo
Service Start Date*

MonthDayYear
Monday – Friday Only | No Weekend Schedule
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Service Address*

Street Address

Street Address Line 2

CityState

Zip Code
Residential Account
Drivers License State*
Drivers License Number*
Upload only front picture of your drivers license

Send only Front
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Commercial Accounts
Tax ID number or EIN*
Upload proof of Tax ID number or EIN

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Applicant Agreement

Applicant must read and sign
Applicant acknowledges and agrees to the terms below,*

I agree that the information I have provided is true, complete, and accurate.I understand that I will be billed for all utility services charged at the above address until such time that services are discontinued.I am responsible for paying for the utility services.I am responsible for placing a deposit to start service.I understand deposits are held in a non-interest-bearing account until my account is terminated.I understand there is an administrative fee to open a new account of $20.00 for each meter that will be added to my first bill.I understand I am billed monthly and I have 25 days to pay or else a one percent (1%) late fee will be applied to all balances. (Chapters 17 & 22 from the City’s Code of Ordinances.)
By typing my name in the below space, I am electronically signing this form. My signing this electronic signature certifies the information to be true, accurate, and complete.*

First NameLast Name
Should be Empty:

Utility Service Application and Agreement

Applicant's Information

Residential Account

Commercial Accounts

Applicant Agreement