Town of Annetta » Application for Utility Service

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Application for Utility Service

Primary Account Contact

Full Name:
State: Driver's License Number: Date of Birth: Home Phone: Work Phone: Email Address:

Service Address

Address:

Own Rent Landlord's Name: Landlord's Phone:

Billing Address (if different from Service Address)

Address:

General Information

Service Type: Residential Commercial Requested Connection Date:

Submit

By clicking submit, you hereby make application to the City of Annetta for utility services currently offered and available to the City (Water and Sewer). You agree to pay for said services as bills are rendered in accordance with the rates, rules, and regulations as provided for by City Ordinance, and to abide by all rules and regulations as now existing or as may be enacted by the City. You further agree to release and discharge the City for any liability for damages suffered from the provision of utility services.