Business Application for Electric Services

Business Name*
Service Address*
Mail Address*
Same Address?
- My mailing address is the same as my service address
Contact Person*
Daytime Phone*
Email*
I wish to have my bills emailed to me*
- Yes
- No
I'm interested in Automatic Payments*
- Yes
- No
Landlord Name
Date of Service Start*
MM slash DD slash YYYY
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 date listed above, 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.
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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