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New Non-Residential Customer Application

  1. My Post Copy (3)

  2. NON-RESIDENTIAL UTILITY SERVICE AGREEMENT

  3. ACCOUNT INFORMATION

  4. I am the business:

  5. Sales Tax Exempt

  6. Preferred Contact Method

  7. EMERGENCY & SECONDARY CONTACTS

  8. MAINTENANCE CONTACTS

  9. AGREEMENT SIGNATURE

  10. Electronic Signature Agreement

    I acknowledge that all High Strength Wastewater customers must request a pretreatment questionnaire form. This document is to be filled out by the appropriate commercial/industrial personnel upon the signing of this service agreement. Furthermore, I understand the pretreatment questionnaire must be returned to the Director of Public Works within thirty days of the initiation of sewer service so the City of Republic can determine if appropriate surcharges for biochemical oxygen demand (BOD), phosphorus (P) and total suspended solids (TSS) are necessary. I agree to abide by all of the City of Republic ordinances regarding water and sewer services and state that all of the information contained on both sides of this service agreement is true and accurate as of this date.

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