Full Address where new Service is Desired (include Apartment # etc if applicable)*

Landlord Name (if applicable)*

Date you wish to have services installed by*

Name: (First/Last)*

Customer Mailing Address*

Phone Number*

Email Address*

Date of Birth*

Employer*

Spouse or Roommate Full Name*

Spouse or Roommate's Employer*

Comments/Notes/Questions for us?

Please be aware:

*After Utility Billing receives a request submitted via the website for new services, staff will need to call the customer to request some additional information and make the appointment to turn services on.

If you do not receive the call from Utility Billing, then this order will not be completed. This would most likely be due to a technical issue or an incorrect phone number given.

*The $26 service fee for turn ons will be added to the first bill for services.

*This form is for use at locations that have had services in the past. If you desire service for newly constructed buildings, please call or come by the Utility Billing office.

*This form will activate standard City services including water, sewer, sanitation, and storm drainage.

*All fields are required.

Payment Policy:
Full Payment is due at time of service. If payment arrangements are needed, please inform us at the time of service. If the account must be fowarded to a collection agency, or Attorney for collection, you will be charged an addition 15% of the balance due for collection/Attorney fees.

Checks that are returned from your Financial Institution are subject to a $30 return check fee.

I have read and agree to the terms and conditions of this policy agreement.

Please Type Full Name*