Utility Customer Application

The following information MUST be provided to become a utility customer. Failure to do so may result in refusal of or termination of service.

The form below will not be considered complete until a utility deposit has been made in person at City Hall or over the phone by calling 402-643-2927.

If you would prefer to print out a form to fill out and submit with your deposit, click here.

Utility deposits will be refunded after 24 months with no late payments. The deposit will be applied to the balance due on the account. Any balance of the deposit will be refunded after the final bill is paid.

Utility Customer Application Form

Required fields are marked with *.

Date of Service*

Customer Name*

Service Address*

Check One*RenterOwner

Number of people living here*

If renter, list landlord* (if you are an owner, type "none" here)

Last 4 digits of social security number*

Phone* Phone Type

Employed by:

Date of birth*

Email Address

Please email my monthly utility billing to the above email address.

Co-Occupants, if different than listed above

Name

Cell Phone

Work Phone

Name

Cell Phone

Work Phone

Signature*
(Please sign your name in the box below using your mouse on a desktop computer or with your finger on a touchscreen.)


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