New Service Application – Winchester Municipal Utilities

(Any applications received after 3:30pm will be processed on the next business day)

Application for Utility Services

Applicant *

Service Address *

Rent
Own

Mailing Address *

Home Phone *

Cell Phone *

Email *

Employer *

Employer Phone *

Spouse Name *

First

Middle

Last

Spouse Employer *

Have you ever had service with us before? *

Previous Address *

Emergency Contact *

First

Last

Emergency Contact Phone *

I would like to give permission for the following individuals to have full access and authority to my WMU accounts:

List, Name Phone Number, and relationship

List all other adults living at the residence: *

I hereby make application for and authorize Winchester Municipal Utilities to provide applicable services requested at the above address. I agree to abide by all rules and regulations of Winchester Municipal Utilities. I hereby certify that I am at least 18 years of age. I agree that I will be responsible and liable for all charges against these accounts, including fees by collection agencies on delinquent accounts, and will make payment of all amounts due on or before due dates. I understand that false or misleading information will be just cause for discontinuance of utility services. Applicant grants permission to WMU to (1) release to the owner of the real estate wherein service is provided all information regarding usage and billing for property and (2) to notify such owner in the even that utility service is disconnected. *

Signature:

Name