Application for Service

Application for Service - Business
After application is submitted, you will receive an email from a staff member regarding required Gas and/or Water 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 Service*

MonthDayYear
SERVICE ADDRESS
Street Address*
Ownership Status*

OwnRent
If renting, owner(s) name
BUSINESS INFORMATION
Business Name*
Tax ID Number*
Phone Number*
Mailing Address*

Address

CityState

Zip Code
BUSINESS OWNER/AUTHORIZED CONTACT PERSON
First*
Last*
Date of Birth

MonthDayYear
Driver's License Number
DL Issuing State
Phone Number*
Email*
EMERGENCY CONTACT
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 applicant.

I have read and understand everything stated on this application.
Signature of Authorized Contact

Clear
Date

MonthDayYear
Should be Empty: