Residential Utility Application

2. Residential Utility Application
   Please fill out the following form to process your request for utility service. Disclaimer: If you submit this form during business hours(Monday thru Friday from 8:00 AM to 5:00 PM) it will be completed the same day. If submitted after hours or holidays it will be completed the following business day. Once the application is complete you will receive a welcome email.

   Please fill out the following form to process your request for utility service. Disclaimer: If you submit this form during business hours(Monday thru Friday from 8:00 AM to 5:00 PM) it will be completed the same day. If submitted after hours or holidays it will be completed the following business day. Once the application is complete you will receive a welcome email.

4. New Service Address*

5. Date to be turned on (Monday thru Friday)*
   Date to be turned on (Monday thru Friday)

7. Name*

8. Mailing Address*

10. Mailing Address City*

11. Mailing Address State*

12. Mailing Address Zip Code*

14. Phone Number

15. Email Address*

16. Paperless Billing?*

    1. Yes
    2. No
18. Are you buying or renting?*

    1. Buying
    2. Renting
19. Purchase/Rental Agreement*

    Attach a copy of your purchase agreement or lease agreement if you are renting.

20. Are you currently a City of Idaho Falls utility customer?

    1. Yes
    2. No

22. Do you wish the utility services turned off at the current address?

    1. Yes
    2. No
23. Current Address:

24. Date to have current service turned off (Monday thru Friday)
    Date to have current service turned off (Monday thru Friday)

28. Two Items of Identification

30. Driver's license or government issued ID #

31. DOB
    DOB

33. Last four digits of social security #

35. Passport #

36. or A# for I-551

38. Picture ID*

    Attach a copy of your government issued picture ID(s).
    (If there is more than one person on a lease, you can scan all IDs into a single image and upload it here.)

42. Names of additional adults listed on the rental agreement or purchase agreement

43. Phone Number(s)

45. Driver's license or government issued ID #

46. DOB
    DOB

48. Last four digits of social security #

50. Passport #

51. or A# for I-551

53. Additional Picture ID(s)

54. Additional Picture ID(s)

55. Additional Picture ID(s)

57. Additional attachments (if any needed)

61. I hereby request utility at the above location and agree to pay for all electric, water, sewer, fiber, and sanitation services used, delivered or made available at this location until I notify the City in writing to discontinue such services. I agree that all utility services will be delivered subject to the terms and provisions of the Idaho Falls City Code as it now exists or may be generally amended from time to time. I understand the City makes no warranties of any kind and all warranties, whether expressed or implied including all warranties of merchantability and fitness for a particular purpose, are expressly disclaimed. I represent that I am either the owner of the premises described above or am leasing or renting the property from the owner. I also represent that neither I nor any member of my household have a delinquent utility account with the City. I understand that any past debt owed to the City must be paid in full before any City utilities can be connected.

    I hereby request utility at the above location and agree to pay for all electric, water, sewer, fiber, and sanitation services used, delivered or made available at this location until I notify the City in writing to discontinue such services. I agree that all utility services will be delivered subject to the terms and provisions of the Idaho Falls City Code as it now exists or may be generally amended from time to time. I understand the City makes no warranties of any kind and all warranties, whether expressed or implied including all warranties of merchantability and fitness for a particular purpose, are expressly disclaimed. I represent that I am either the owner of the premises described above or am leasing or renting the property from the owner. I also represent that neither I nor any member of my household have a delinquent utility account with the City. I understand that any past debt owed to the City must be paid in full before any City utilities can be connected.

63. Customer Agreement

    By selecting the "I Agree" button, you are signing this Agreement electronically. You agree that your electronic signature is the legal equivalent of your handwritten signature and you consent to be legally bound by this Agreement's terms and conditions.

    1. I Agree
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit Submit and Print

* indicates a required field