Service Address:

Service/Possession Date:

Name for Billing:

Mailing Address for Billing:

Home Phone Number:

Work Phone Number:

Work Business Name:

Date of Birth:

SSN# or Driver's Lic #:

Notes:

Recycle Bin:

Yes

No

Deliver

All New Customers must pay a $50.00 deposit to start service.
Your deposit will be applied to your account as a credit after twelve(12) consecutive
months of on-time payments or at the time you close your account whichever comes first.

By submitting this registration agreement, I understand that the City of Post Falls will
begin utility services in my name for the address listed above on the above possession
date. I am solely responsible for payment for said utilities until such time I am no
longer the legal owner of this property and will notify the City at that time.