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2. Service Address*
3. Apartment number (if applicable)
5. City*
6. State*
7. Zip Code*
9. What date do you need service to start? *
   What date do you need service to start?
10. Number of people living in the house?*
12. Primary Customer Name
14. First Name*
15. Middle Initial
16. Last Name *
18. Date of Birth*
20. Driver's License Number or Passport Number*
21. Upload a Copy of Your Driver's License or Passport. *
23. Secondary Customer Name (not required)
25. First Name
26. Middle Initial
27. Last Name
29. Date of Birth
31. Driver's License Number or Passport Number
32. Upload a Copy of Your Driver's License or Passport.
36. Primary Phone Number*
37. Alternate Phone Number
39. Email *
41. Would you like to receive your bill via email? (A paper copy will not be mailed)*

    1. Yes
    2. No
43. Are you renting this home/apartment? *

    1. Yes
    2. No
45. Landlord's Name*
46. Landlord's Phone Number*
48. Landlord's Address*
50. City*
51. State*
52. Zip Code*
54. 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.

56. I understand and acknowledge the statement above.*

    Type first and last name to sign digitally.

Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field