Utility Service(s) Request

Utility Service(s) Request

This form is used to establish utility services.

Do not report emergencies with this form!
Dial 9-1-1 for all emergencies!

 

* Denotes a required field
 

Customer Information

*
 
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Social Security Number*
--
 
*
Daytime Telephone 
-- ext 
Evening Telephone 
-- ext 
Mobile Telephone 
-- ext 

Customer's Employer

 
 
Employer's Telephone 
-- ext 

Requested Services

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Do you want to start City Services (Water, Garbage Collection & Sewer), if available?*
If yes, when would you like to start City Services? 
 If yes, when would you like to start City Services?
Will you need Natural Gas, if available?*
If yes, when would you like to start Natural Gas? 
 If yes, when would you like to start Natural Gas?

By electronically signing below in all caps, the customer agrees to be billed the necessary deposits to establish services. Generally, there is a $150.00 water deposit required and a $150.00 gas deposit required (if applicable). Deposits for businesses will be more.
NEW TAPS: If the City's water works, sewer system, or gas system has not already been "tapped" there will be additional charges for these services.
Prior to the establishment of any services, City Hall must receive a photocopy of the Customer's Identification and a rent receipt (if a renter). Please fax the Identification and information to (229) 246-7311 to the attention of the BILLING COORDINATOR.
You must be present at the service location in order to have services connected.

*Please type in all capital letters to electronically sign.
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Date*
 Date
 


 



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