Action Center / WMU Utilities Activation Form (Commercial) / Washington, IN

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WMU Utilities Activation Form (Commercial)

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This is the commercial utilities request form

* Denotes a required field

Commercial Utilities Activation Form

IS THE SERVICE ADDRESS INSIDE OR OUTSIDE CITY LIMITS?

Business Name

Address

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.

City

State

Zip Code

Zip-Zip +4
Second portion of ZIP Code is optional.

Tax ID Number

Tax Exempt (If yes, form required)

Yes No

Telephone Number

Phone Area Code-Phone 3-Phone 4 ext Extension

Fax Number

Phone Area Code-Phone 3-Phone 4 ext Extension

Business Owner Information

Name

Please Do Not Complete The Following Field

Address

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.

City

State

Zip Code

Zip-Zip +4
Second portion of ZIP Code is optional.

Email Address

Driver's License Number

Social Security Number

Date of Birth

Telephone Number

Phone Area Code-Phone 3-Phone 4 ext Extension

Billing Name and Address (If different from service address)

Name

Address

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.

City

State

Zip Code

Zip-Zip +4
Second portion of ZIP Code is optional.

Requested Date of Service Connection

Utilities Requested

Electric

Water

Sewer

Trash service provided by

Security Question/Answer

I have read through the above information and duly attest that the above responses are true. I understand that misrepresentation or omission of any facts or information called for on this application is subject to any and all City of Washington codes and/or ordinances. I understand that if such information is found to be false (fraudulent), the City of Washington will be bound to resolve this matter in accordance to its policies, codes, and/or ordinances, which may include any necessary fees or fines.

Signature*

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The City of Washington, Indiana

Small City... Big Possibilities

WMU Utilities Activation Form (Commercial)

Commercial Utilities Activation Form

Business Owner Information

Billing Name and Address (If different from service address)

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