City of Byron - COMMERCIAL UTILITY APPLICATION

COMMERCIAL UTILITY APPLICATION

CITY OF BYRON
Date Service Begins*

MonthDayYear
Date
Business Name*
EIN/SSN*
Local Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Type of business*
Opt in to Paperless Billing?*

YesNo
How would you like to pay the deposit and application fee?*

Bill mePay in person
Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Office Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Office Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature*
Date*

MonthDayYear
Date
Please verify that you are human*
FOR CITY OF BYRON USE ONLY:
Amount Paid
Payment Type
Receipt #
Should be Empty: