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Residential Application for Utility Services: Electric, Water, Sewer, and Garbage

2. Date to begin service / responsible for service beginning*
   Date to begin service / responsible for service beginning

   River Falls Municipal Utilities (electric, water, sewer) and garbage/recycling.

3. Pre-authorized Payment (PAP)

   1. Yes! I wish to participate

   Fill out the PAP Form found at http://www.rfcity.org/DocumentCenter/View/1131 and include a voided check and drop off or mail to: RFMU, 222 Lewis Street, River Falls, WI

5. Service Property*

   1. Rent
   2. Own

6. If renting, landlord name / phone number

7. If renting, other adults on lease or living at this property

9. Applicant name (first name and last name)*

10. Spouse's name

12. Primary phone*

13. Alternate phone

15. Email address*

17. Service address*

18. Apt #

19. River Falls, WI 54022

21. Mailing address

    If different than service address. Include Street/PO Box, City, State, Zip

23. Previous address*

    Include Street/PO Box, City, State, Zip

25. If your previous address is within River Falls Municipal Utilities service territory, do you need it discontinued?*

    1. Yes
    2. No

26. If Yes, what date would you like it discontinued?

28. Have you been billed by this utility in the past (in your name)?*

    1. Yes
    2. No

29. If Yes, what year?

31. Applicants employer*

32. City, State*

34. Spouse's employer

35. City, State

37. Emergency contact*

38. Phone*

    Emergency Contact's Phone Number

40. 

41. Renewable Energy Block Program

    1. YES, I agree to purchase 1 Block of Renewable Energy at $3.00 per month. Clean, affordable, power from natural resources like wind, solar and biogas.

    This purchase will appear as an additional charge on my monthly utility bill. Additional blocks are available for $3/block. I understand that I can change my participation level or cancel at any time.

43. I agree to abide by the rules and regulations set forth by this utility and to pay for services at the specified rate. Utility rules require that assigned rate schedules remain in effect for a minimum of twelve (12) months. I understand that a non-payment of utility bills could result in interrupted service and require posting of a deposit. It is understood that current copies of the utility rules, regulations and rates are on file at the utility office and available to me for my information. Upon termination of this service, I understand that it is my responsibility to notify the Utility to request my utility service be terminated or changed from my name.

    I agree to abide by the rules and regulations set forth by this utility and to pay for services at the specified rate. Utility rules require that assigned rate schedules remain in effect for a minimum of twelve (12) months. I understand that a non-payment of utility bills could result in interrupted service and require posting of a deposit. It is understood that current copies of the utility rules, regulations and rates are on file at the utility office and available to me for my information. Upon termination of this service, I understand that it is my responsibility to notify the Utility to request my utility service be terminated or changed from my name.

45. Customer Signature*

46. Date*

Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field