Application for Service

Application for Service

After application is submitted, EMU staff will contact you by email regarding deposits.

Service application must be made at least ONE business day prior to the date you would like services put in your name.

Business days are Monday through Friday, except holidays.

Date to Transfer Services*

SERVICE ADDRESS

Street Address*

Ownership Status*

OwnRent

If renting, owner(s) name

PRIMARY APPLICANT

(Responsible for all decisions regarding this account)

Name*

First NameLast Name

Mailing Address*

City*

State*

ZIP*

Social Security Number*

Date of Birth*

Driver's License Number*

DL Issuing State*

Email Address*

Phone Number*

Employer*

Work Phone Number

SECONDARY APPLICANT

(SPOUSE, who is also responsible this account)

Name

First NameLast Name

Date of Birth

Phone Number

ROOMATES

(18 years old & over)

Name

Phone Number

Name

Phone Number

EMERGENCY CONTACT

(Utility Emergency & we are unable to contact you)

Name*

Phone Number*

I hereby apply for utility services and agree to pay Emmetsburg Municipal Utilities all charges incurred in the accordance with the rates, rules and regulations legally in effect and on file at the utility. I understand I am required to pay a deposit, which will be refunded or credited to my account at the completion of 12 billing periods which NO late charges have been assessed. If the account is closed before the 12-month period, the deposit will be applied to the final billing and the balance returned to the primary account applicant. I have read and understand everything stated on this application.

Signature of Primary Applicant*

Date*