City of Walnut

229 Antique City Dr.

P.O. Box 326

Walnut, Iowa 51577

 

 

Name of Applicant:                                                                    .

Social Security Number:                                                            .

Service Address:                                                                       .

Mailing Address:                                                                        .

Telephone Number:                                                                   .

Beginning Meter Read:                                                              .

Deposit Amount:                      Date Received:                        .

 

If Renting:

Landlord’s Name:                                                                      .

 

I, hereby apply for utility services, for the premises listed above beginning the                     day of                                   , 20      , pursuant of the rules and regulations of the City of Walnut, I agree to pay all bills rendered by the City of Walnut until I give notice to the City of Walnut to discontinue said utility services.

 

                                              .                                              .

City of Walnut                                                                       Signature of Applicant

 

 

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Date                                                                                  Date