New Customer Utility Account
Use this form to set up a new utility account. Do not use if you are an existing or returning customer to the City of Centralia, Missouri.
Deposits Required*
Utility deposits are required for new accounts or returning customers. The amount of a regular deposit is $100 for electric and $50 for water, plus the first month's trash fee in advance in the amount of $16. Once this form has been received by City Hall and an account has been created by City staff, an email with the total deposit and advance trash amounts due will be emailed to the address provided below. A letter of credit may be provided to cityhall@centraliamo.org, and if it meets the criteria outlined in our policy, the deposit may be waived. If the deposit is waived, the advance trash fee will still be due. 24-hour notice is required to set up new utility accounts. Applications received after 3:00 p.m. on Friday afternoons will be processed the next business day. City Hall is open Monday - Friday, 8:00 a.m. - 5:00 p.m. All City holidays are listed on our website www.centraliamo.org
Applicant Name
*
First Name
Last Name
Co-Applicant Name
First Name
Last Name
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the mailing address the same as the service connection address?
Please Select
Yes
No
If No, enter the service connection address below.
Service Connection Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
Alternate Phone Number
Please enter a valid phone number.
E-mail
*
example@example.com
Driver's License No.
*
Photo of Picture ID
Date services are to be connected:
*
-
Month
-
Day
Year
24-hour notice is required.
Additional Details - Please Provide any additional information you feel is relevant.
Signature
*
Submit
Should be Empty: