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Residential Application for Electric Services

Name*
First Last
Renting or buying?*
- Renting
- Buying
Landlord*
Name Address Phone
** Rental properties require a deposit before electricity service is connected. You will receive a confirmation email with the deposit amount within 24 hours of your requested service date. **
Service Address*
Mail Address*
Same Address?
- My mailing address is the same as my service address
Date of Service Start*
MM slash DD slash YYYY
Phone*
Email*
I wish to have my bills emailed to me*
- Yes
- No
I'm interested in Automatic Payments*
- Yes
- No
Date of Birth*
Month
Day
Year
Driver's License #*
Drivers License State*
International ID Country*
Employer*
Name Address Phone
Relative/Contact Person*
Name Address Phone
Spouse / Roommate Information
Spouse / Roomate?
- I don’t have a spouse or roommate
Spouse / Roommate Information 1
First & Last Name Phone Email Birthdate
Spouse / Roommate Information 2
Driver's License Number Driver's License State Employer Employer Phone
I hereby apply to the Story City Municipal Electric Utility for utility service to be delivered at the service address listed above beginning on the selected date, in accordance with the Utility’s rules. I agree to pay all bills rendered for utility consumption until I notify the Utility Office to discontinue said service. I also understand that a deposit is required upon start of service for rental properties.
Signature of Owner, Officer, or Authorized Agent of Business*
Today's Date*
PROJECT SHARE is a program which allows customers of the Utility to assist low income customers of the utility with their wintertime bills. Customers may apply for Project Share funds through Mid-Iowa Community Action.
Project Share Opt In*
- Yes, I pledge to make a charitable contribution.
- No, I do not wish to make a monthly pledge at this time.
Dollar amount per month you'd like to contribute to Project Share*
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