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
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
Zip Code

New Service Address Information
Street Address
Apt. Lot or Unit Number
City
State
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
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