Application for Business Services

Name

This field is for validation purposes and should be left unchanged.

Application for:*

Service Address*

Street Address City State ZIP Code

Services Needed*

Electric

Water

Sewer

Recycling

Storm Water

Date of Service*

Name as you want to appear on the account

Billing Address*

Street Address City State ZIP Code

Billing contact info, please include name(s) and phone number of who we may contact*

Business name as you want it to appear on your account(s):*

Is Mailing Address Same as Service Address?

Yes

Mailing Address*

Street Address City State ZIP Code

Accounts payble contact information:

Property Owner’s Name*

(First and Last Name)

SSN No. or EIN*

Name*

(First and Last Name)

Phone Number*

Email Address*

Home Phone Number*

Cell Phone Number*

Work Phone Number*

Business/Office Number*

EIN No.*

Is there anyone else we can talk to regarding your properties (I.e. managers, employees)?

Property owner name(s)*

(First and Last Name)

Property Owner Phone Number*

Are you Renting?*

Yes

Please list all of your properties in Indianola below*

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Valid Drivers License or Photo ID

Max. file size: 128 MB.

**A CONNECTION FEE WILL BE CHARGED EACH TIME THE PROPERTY CHANGES HANDS. THIS WILL APPEAR AS A CHARGE ON YOUR BILL**

Signature*

If you are a landlord or business owner, please fill out the form below to request utility services. If you have any questions, please contact us at 515-961-9444.