2. CITY OF MINNEAPOLIS UTLITY CONNECTION APPLICATION
4. Date
6. First Name
7. Last Name
9. New Address
11. Birth Date
12. Phone Number
14. Social Security Number
15. Driver's License Number
17. Occupation
18. Employer
20. Move In Date:
21. Utilities

    1. Water/Sewer
    2. Electric
23. Old Address (if in town)
25. Move Out Date:
26. Utilities

    1. Water/Sewer
    2. Electric
28. Mailing Address (if different)
30. List any Co-Occupants Here
32. If you would like Bills and Late Notices Emailed, Please List Your Email
34. Do You...

    1. Own
    2. Rent
35. If Rent, Landlord Name
37. I will pay my connection fees...

    1. Over the phone
    2. In person

    PAYMENT MUST BE MADE BEFORE SERVICE IS TRANSFERRED INTO YOUR NAME.

39. Agreement Acknowledgement

    I agree to abide by all the rules and regulations of the City now in force, or hereafter to be fixed by the city, relating to the operation of its utiliities; and pay all bills for utility service received, used or wasted at the above address during the period of this contract. Any unpaid balance constitutes delinquencies on all utilities. In the event of delinquencies, any and all reasonable incurred collection, attorney fees, and court costs will be added to the balance. If there is more than one account, a delinquency on one account constitiutes delinquencies on all accounts

    This agreement is to be in effect from the date hereof to the date service is discontinued upon my request or for other reasons by the City.

    I acknowledge that all of the information on this form is accurate and the person filling out this form is the applicant listed on the account. 

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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

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