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Application for Utilities and Services

  1. Services Required*

  2. If you selected other, please explain.

  3. Check One*

  4. Applicant's Employer Information

  5. References

  6. (i.e., Customer or dependent in household on respirator or other life support system)

  7. Authorization

    We hereby apply for utilities and services at the address stated under terms and conditions as approved by the St. James City Council and agree to pay all charges at the given rates within the given payment period. I/We have received a copy of the Public Utility Rules and Regulations.

  8. Signature*

    Check yes below to finalize your application for utilities and services.

  9. Leave This Blank:

  10. This field is not part of the form submission.