Required fields are marked with asterisks (*)

Utility Service Request Form

New Service Request

WATER - SEWER - REFUSE

Service Address

Close of Escrow Date

OWNER INFORMATION: (STRICTLY CONFIDENTIAL)

Are there one or two owners?

One

Two

Do you have a separate Billing Address?

Yes

No - Same as above

Home Phone Number

Work Phone Number

Cell Phone Number

Email Address

MUST PROVIDE SSN AND GOVERNMENT ISSUED I.D. FOR EACH OWNER

(Example: Government Issue ID can be a Driver's License, State Issued ID,
Passport Number or Military ID Number)

Owner One - Social Security Number

Owner Two - Social Security Number

Owner One - State Issued ID

Owner Two - State Issued ID

Will you be adding a tenant or a property manager to your property?

Yes

*Only an owner or Property Manager who is on the account can add and remove a tenant. We add tenants on the 1^st of a month and remove them on the last day of the month.*

SERVICE AGREEMENT

The City of Lincoln will charge a twenty three dollar ($23.00) processing fees to set up your account. This amount will reflect on your first bill.

Customer agrees to pay all utility charges in a timely manner. Current charges are due the first of the month. All fees or charges which are not paid on or before the thirtieth (30) day following the date such charges were due and payable will be considered delinquent. A ten (10) percent interest of the charge shall be imposed and due upon mailing of a reminder notice. An additional charge of $8.00 will be assessed if a door tag delinquent notification is placed on the property.

The undersigned (customer) agrees to be responsible for any damages to the bin and to personal and public property for the duration of the lease and agrees to return the bin in a satisfactory condition.

In the event of a non-payment, utility service will be terminated. Customer will be required to pay a service charge of $57.00 - $ 171.00 and up to the full account balance before service is restored.

In the event payment is not made, the property owner is responsible for any unpaid balance on the account and all service charges if service is terminated for non-payment. At its option, the City of Lincoln may place a lien on the property for all amounts owed.

Forms

Utility Service Request Form

New Service Request

OWNER INFORMATION: (STRICTLY CONFIDENTIAL)

MUST PROVIDE SSN AND GOVERNMENT ISSUED I.D. FOR EACH OWNER

(Example: Government Issue ID can be a Driver's License, State Issued ID, Passport Number or Military ID Number)

SERVICE AGREEMENT

BEFORE SUBMITTING THIS APPLICATION, PLEASE VERIFY THE SERVICE ADDRESS

(Example: Government Issue ID can be a Driver's License, State Issued ID,
Passport Number or Military ID Number)

BEFORE SUBMITTING THIS APPLICATION,
PLEASE VERIFY THE SERVICE ADDRESS