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APPLICATION FOR UTILITIES SERVICE

  1. COH logo overlay
  2. All contracts for municipal utility service shall be signed in the true name of the customer(s) actually to receive and use such service. Any changes in the identity of the contracting customer at premises shall require a new application. The City may discontinue any municipal utility service until the City has accepted such new applications. Ordinance No. 2692 Sec. 700.080 Utility Service Application required.
  3. APPLICANT(S):
  4. ALL ADULTS LIVING AT THE SERVICE ADDRESS MUST BE INCLUDED ON THIS APPLICATION.

    SOCIAL SECURITY NUMBER IS REQUIRED BUT WILL NOT BE ACCEPTED VIA THIS FORM.

    PLEASE FOLLOW UP WITH THE UTILITY BILLING OFFICE 816-380-8900.

  5. ALL ADULTS LIVING AT THE SERVICE ADDRESS MUST BE INCLUDED ON THIS APPLICATION.
  6. FOR SERVICE AT:
  7. Do you have access to a printer?*
    Check yes or no
  8. BILLING ADDRESS IF DIFFERENT FROM ABOVE:
  9. EMERGENCY CONTACT INFORMATION (Not someone living at the service address)
  10. Leave This Blank:

  11. This field is not part of the form submission.