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APPLICATION FOR CITY OF MANCHESTER UTILITY SERVICES

208 E Main Street, Manchester, IA 52057

Phone: 563-927-1114

Email: jschmitz@manchester-ia.org

 Renter

 New Owner

If you are a new owner and plan to rent this property, additional paperwork will be required. 

ADDRESS:   POSSESSION: 

APPLICANT INFORMATION

Name(s) on the Account: 

 Yes  No  I have had City of Manchester utility services in the past. Names(s): 

 Yes  No  My spouse/roommate have had the City of Manchester utility services in the past. Names(s): 

Mailing address (if different that the property address): 

Mobile Number:  Social Security Number: 

DOB:  Driver's License #:  

Email: 

 By checking this box, I am requesting paperless billing. I understand I will not receive a paper bill. 

ACKNOWLEDGMENT

 I understand it is my responsibility to contact the City Office to obtain my balance if I have not received my bill by the first working day of the month. 

 I understand my utility bill is due by the close of business on the 10th day of the month. 

 I understand I can pay my utility bill via cash/check/money order, debit/credit, in-office, mail, drop box, bill pay, online, or via automatic withdrawal. 

 I understand if my utility bill is not paid by the close of business on the 10th day of the month, I may be subject to penalties and/or disconnection of services. 

 I understand if I am unable to pay my bill on time it is my responsibility to contact the City Office to make payment arrangements. If the terms of the payment arrangements are not met, I may be subject to disconnection of services and my utilities will not be reconnected until my bill is paid in full for all charges incurred for shutoff. 

 I understand I am responsible for all utility charges for services provided to this location until notification is received, from me, to discontinue service. 

Signature 

Date