Utility Forms

Evansville Water & Light Utility Service Application & Agreement

Please complete all sections that apply to you. Application for service shall be made in the legal name of the party obligated to pay for the service. Customers are required to provide information (full name and date of birth) and proof identification which can be one of the following: Driver’s license, passport, or last 4 of SSN as identified. Failure to provide such information may result in disconnection of services.

Section 1: Property Information

Account #:

Type of Property:

Owner:

Tenant:

Service Address: (Street, Unit, City) *

Mailing Address: (If Different) (Street, Unit, City, State, Zip)

Start Date of Service:

Is this a commercial Account: No Yes

If yes, please fill the next sections completely.

Name of Business:

Federal ID No:

Section 2: Applicant Information (Primary)

Applicant Name:

Phone:

Social Security No: (last four digits)

Date of Birth:

Driver's License No:

Email:

Applicant Information (Secondary, if applicable)

Applicant Name:

Phone:

Social Security No: (last four digits)

Date of Birth:

Driver's License No:

Email:

Do you currently have utility service with Evansville Water & Light? No Yes

If yes, please provide service address(es):

Would you like to enroll in our Automatic Bank Draft Payment Option? No Yes

NOTE: To sign up for this service with a credit/debit card, please activate an online account at www.ci.evansville.wi.gov/life_in_evansville/pay_my_bills/ to sign up for this payment option.

I agree that the information I have provided is true, complete, and accurate. I understand that I will be billed for all utility services charged at the above addresses until such time that services are discontinued. * I agree

City Of Evansville - WI

Utility Forms

Evansville Water & Light Utility Service Application & Agreement