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2. 
5. MCUS Utility Service Application
7. Applicant's Name*
8. Service Address*
10. Mailing Address (if different from service address)
12. City*
13. Date to Begin Service*
    Date to Begin Service
    Select the date you wish service to be transferred into your name.
15. State*
16. Zip*
18. Phone Number*
19. Email Address*
21. Do you want your phone number entered into the community notification system to receive alerts on boil orders, public works projects and community emergencies?*

    1. Yes
    2. No
23. Are you new to the Monticello community?*

    1. Yes
    2. No
25. Emergency Contact*
    Please provide the name and phone number of an emergency contact of someone who will not be living at this residence.
27. Applying As:*

    **If you are a renter or mobile home dweller, you must pay a $75 deposit to the MCUS office before service will be transferred into your name.
    **Landlords must complete a separate application.

    1. Owner and Resident of the Property
    2. Renter of the Property
    3. Mobile Home Dweller
29. Landlord/Property Owner
    If you are a renter, please provide the name and phone number of the landlord/owner of the property.
30. Signature of person making the request*
32. Do you agree?*

    By clicking "I agree," you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature 3) You agree to abide by and be bound by all provisions of the City of Monticello Ordinance 4) You accept responsibility for all unpaid utility bills.

    1. I Agree
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field