Create a Website Account - Manage notification subscriptions, save form progress and more.
Choose the following option that you prefer for your summer sewer rate:
Type full name here for signature
For YES, please type full name here for signature
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. I/We agree to abide by the Republic City Ordinances/Regulations pertaining to utility services; that all the above information is true and accurate; and that I/We are responsible for all billings until written notification is provided to the City to discontinue service.
This field is not part of the form submission.
* indicates a required field