Utility Service Application

Click here for Printable Form


Americas/Chicago
Service Address
Required

Primary Applicant

Required
Required
Required
Required
Americas/Chicago
Required
Required
Mailing Address (if different from Service Address)
Employer Address

Landlord Information

Only need to fill out if you are renting the property requesting service.

Landlord Address

Co-Tenant Information Required

Persons listed as co-tenants will be responsible for the utility service in the event of default by the primary applicant.

Social Security Number is required. Once your application has been submitted, please call us with your Social Security Number.

Americas/Chicago
Employer Address

Applicant(s) understand that the use of said utility services will be governed by the ordinance of the City of Auburn, Kansas, that the present rates may change from time to time by action of the Governing Body of the City, and that the City does not warrant and ensure the uninterrupted service of any utility. Applicant agrees to abide by all laws and ordinances concerning the use and prompt payment for such utility service.

The Privacy Act regulates the use of Social Security Numbers by government agencies. The City of Auburn requires the disclosure of Social Security Numbers upon completing a service application. The SSN may be used to collect delinquent account balances through the State of Kansas Setoff Program or contracted collection agency. No other use or distribution of SSN will be allowed. Failure to disclose required SSN will result in a denial of utility services.

Signature

Required
Americas/Chicago

Include a copy of current DL or ID.

Letter of Credit from most recent utility service (gas, electric, water) to decide if a utility deposit is needed.