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2. 
3. Utility Billing Department

   Yard Meter Reconnection/Disconnection

5. Service Address*
6. Date:*
   Date:
8. Select One:*

   1. Reconnection

   1. Disconnection

9. Service Connection only Monday-Friday.

   24-Hour notice is required. No service on Holidays.

11. Additional Requests:
13. Applicant Name:*
14. Date of Birth:*
    Date of Birth:
16. Driver's License #:*
17. Driver's License Photo:*

    Upload a photo of your driver's license

19. Social Security #:*

    Last four digits only.

21. Phone Number:*
23. Email Address:*
25. By checking the boxes below, you agree to the following:*

    1. I understand a $35 reconnection fee will be added to my utility bill.
    2. I understand that government issued PHOTO IDENTIFICATION is required for connection/disconnection. A scanned copy or photo is fine.
27. Applicant Signature*
28. Today's Date:*
    Today's Date:
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field