OLD Utility Account Set-Up

Today's Date *

Please Indicate the Start Date of Your Service *

Property Address for New Service *

Purpose of Service Residential Home
Commercial Business
Multi-Family Housing
Industrial

If Applicable, type of Commercial Business or Industry?

Are you the * Property Owner
Tenant (Renter)
Owner's Manager

Property Owner's Name

Property Owner's Address

Would you like the Water Turned On? Please check "yes" or "no" * Yes
No

If Yes, please Indicate the Date you would like Water turned on

1. Applicant's Name *

2. Applicant's Name (Please enter N/A if not applicable) *

Mailing Address *

City *

State *

Zip Code *

Phone Number *

E-Mail

Have you ever received utility services from the City of Sheridan before? * Yes
No

If Yes, what address?

I understand that by signing and submitting this application, I must abide by the regulations governing use of the Sheridan Water System, and that this application is merely a request for service and does not bind the City of Sheridan to provide service. * Acknowledge

I also understand that the deposit is not to be considered a payment on account. * Acknowledge

SIGNATURE *

**** BELOW THIS LINE IS FOR OFFICE USE ONLY ****

Account #

Date Deposit Received

Deposit Amount

Date Deposit Returned

Check #

* - denotes required field