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2. Service Address*
4. City*
5. State*
6. Zip Code*
8. Business Name*
9. What date do you need service to start? *
   What date do you need service to start?
11. Tax ID number*
13. Contact Person
15. First Name*
16. Last Name *
18. Mailing Address (if different than service address)*
20. City
21. State
22. Zip Code
24. Primary Phone Number*
26. Email *
28. Would you like to receive your bill via email? (A paper copy will not be mailed)

    1. Yes
    2. No
30. Are you renting this space? *

    1. Yes
    2. No
32. Landlord's Name*
33. Landlord's Phone Number*
35. Landlord's Address*
37. City*
38. State*
39. Zip Code*
41. Acknowledgement

    Submittal of this application indicates agreement to abide by the rules of the utility, paying bills rendered and providing the City access to the city meters, wires and pipes at reasonable times as provided by law.  

    Note: Personal Information and phone numbers are for customer security and City use only.

43. I understand and acknowledge the statement above.*

    Type first and last name to sign digitally.

Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field