TRANSFER SERVICE APPLICATION

---

City of Boone Water/Sewer Utilities Online Customer Service

Applicant Information First Name   * Middle Initial   Last Name   * Date of Birth (click on date from calendar)   * * Social Security Number (xxx-xx-xxxx)   * * Driver's License Number   Driver's License State   Alaska Alabama Arkansas Arizona California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Employer   Work Telephone   Are you Married?   Yes No *
Your Boone Municipal Utilities Account Number: (your account number is printed on your bill)   *
Date you want service to stop:   * * *   Date you want service to begin:   * * * Dates available are Monday through Friday, excluding Holidays. A requested date may be changed up to two (2) work days to coincide with an existing request or if the date is not a normal work day.
Present Service Address Information Street Address   * Apt. Lot or Unit Number   City   * State   Alaska Alabama Arkansas Arizona California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip Code   *		New Service Address Information Street Address   * Apt. Lot or Unit Number   City   * State   Alaska Alabama Arkansas Arizona California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip Code   * Do you want your utility bill mailed to an address other than your service address?  Yes No *
Other Information Current Phone Number   * Will this be your telephone number at your new address?  Yes No * E-mail Address   * * Will You Own or Rent?   Own Rent Contract * Landlord's Name   * Landlord's Telephone   Would you like to participate in the Leak Protection Program? Yes – I understand this program protects me in the event of an accidental water leak yielding a large water/sewer bill. I understand there is a monthly .50 cent fee. See www.boonegov.com for more information.   No – I do not want to participate in the Leak Protection Program. I understand that I will be fully responsible for all water/sewer charges regardless of accidental leak or water line break.		In Case of an Emergency Contact's Name   * Contact's Address   * Contact's City   * Contact's State   Alaska Alabama Arkansas Arizona California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Contact's Zip Code   * Contact's Telephone
Your payment history will be reviewed to determine if a new or additional deposit is required. If a new or additional deposit is required, then it will be billed to your account.
Additional Comments * 500 character maximum