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2. 
4. 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.
6. APPLICANT(S):
8. 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.

10. Name 1*
12. Date of Birth*
13. Employer*
15. Daytime Phone Number*
16. Email Address*
18. Name 2
20. Date of Birth
21. Employer
23. Daytime Phone Number
25. Name 3
27. Date of Birth
28. Employer
30. Daytime Phone Number
32. ALL ADULTS LIVING AT THE SERVICE ADDRESS MUST BE INCLUDED ON THIS APPLICATION.
36. FOR SERVICE AT:
38. Address*
39. Apartment Number (If applicable)
41. Landlord's Name*
43. Services Beginning On:*
45. Do you have access to a printer?*

    Check yes or no

    1. Yes
    2. No
47. Please include a high-resolution picture or scan of your drivers license
49. Please include a copy of the first page of your lease or a copy of your closing papers*
53. BILLING ADDRESS IF DIFFERENT FROM ABOVE:
55. Address
56. City/State
58. Zip Code
59. Phone Number
63. EMERGENCY CONTACT INFORMATION (Not someone living at the service address)
65. Relative's Name*
66. Relative's Phone Number*
68. Address*
69. City/State*
71. Zip Code*
Leave This Blank:


73. 1. Receive an email copy of this form.
74. Email address

    This field is not part of the form submission.

75. Submit

* indicates a required field