Utility Application

SERVICES APPLICATION /AGREEMENT

IMPORTANT NOTE: New Applications require a photo ID in addition not either a rental agreement or proof of ownership. Please be certain to leave appropriate contact information or apply for service in person or on the phone because service WILL NOT be initiated until the required documents have been submitted.

Customer Information/Residential or Business OR Update Account Information for Address Change

If you would rather download the form and fill it out and return to the city .

Type of Account

Residential

Business

First Name

Middle Name

Last Name

Driver License #

Employment

Spouse

First Name

Middle Name

Last Name

Driver License #

Employment

Business Name

Applicant Information

Home Phone

Cell Phone

Applicant Email Address

Mailing Address

City

State

Zip Code

Service Location

City

State

Zip Code

Dumpster Request:

Do you need a Dumpster?

Yes

Type of Dumpster:

Rent

Purchase

Size:

Amount Charged:

Delivery Date:

Pickup Schedule:

COMPLIANCE WITH FEDERAL RECORD KEEPING REQUIREMENTS
Federal Law prohibiting discrimination against applicants. You are not required to provide this information, but are encouraged to do so.

Race/Ethnicity:

American Indian/Alaskan Native

Hispanic or Latino

Asian

Black or African American

White

The trash can is rental only and it is an additional $3 per month. If lost, stolen or damaged they are responsible for it.

SERVICES APPLICATION /AGREEMENT

Service Location

Dumpster Request:

Information Summary

Payments

Apply for ...

Report

Parking

Reservations

Agenda & Minutes

Development Services

I want to ...

Community

Business

Government