Form Center

2. What type of service are you transferring?*

   1. For my home/apartment
   2. For my business
4. Name of person requesting change
6. First Name*
7. Last Name*
9. Name Listed On The Account*
11. Current Address*
12. Apartment number (if applicable)
14. City*
15. State*
16. Zip Code*
18. What date do you need service to stop at your current address? *
    What date do you need service to stop at your current address?
22. New Ankeny Address*
23. Apartment number (if applicable)
25. City*
26. State*
27. Zip Code*
29. Number of people living at the new address?*
30. Date to Start Service at New Ankeny Address?*
    Date to Start Service at New Ankeny Address?
34. Primary Customer Name
36. First Name*
37. Middle Initial
38. Last Name *
40. Date of Birth*
41. Primary Phone Number*
43. Driver's License Number or Passport Number*
44. Upload a copy of your driver's license or passport. *
46. Email *
48. Would you like to receive your bill via email? (A paper copy will not be mailed)

    1. Yes
    2. No
50. Are you renting/leasing the new home/apartment/office space? *

    1. Yes
    2. No
52. Landlord's Name*
53. Landlord's Phone Number*
55. Landlord's Address*
57. City*
58. State*
59. Zip Code*
61. 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.  It also give the city permission to stop service at your current address and start service at your new address.

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

63. I understand and acknowledge the statement above.*

    Type first and last name to sign digitally.

65. To receive a copy of your submission, please fill out your email address and submit.
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field